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Head CT for Minor Head Injury Presenting to the Emergency Department in the Era of Choosing Wisely

  • Author(s): DeAngelis, John
  • Lou, Valerie
  • Li, Timmy
  • Tran, Henry
  • Bremjit, Praneeta
  • McCann, Molly
  • Crane, Peter
  • Jones, Courtney
  • et al.
Abstract

Introduction: The Choosing Wisely campaign currently recommends avoiding computed tomography(CT) of the head in low-risk emergency department (ED) patients with minor head injury, based onvalidated decision rules. However, the degree of adherence to this guideline in clinical practice isunknown. The objective of this study was to evaluate adherence to the Choosing Wisely campaign’srecommendations regarding head CT imaging of patients with minor head injury in the ED.

Methods: We conducted a retrospective cohort study of adult ED patients at a Level I traumacenter. Patients aged ≥ 18 years who presented to the ED with minor head injury were identified viaInternational Classification of Diseases, 9th Revision, Clinical Modification codes. Medical recordabstraction was conducted to determine the presence of clinical symptoms of the NEXUS II criteria,medical resource use, and head CT findings. We used descriptive statistics to characterize the studysample, and proportions were used to quantify guidelines adherence.

Results: A total of 489 subjects met inclusion criteria. ED providers appropriately applied the ChoosingWisely criteria for 75.5% of patients, obtaining head CTs when indicated by the NEXUS II rule (41.5%),and not obtaining head CTs when the NEXUS II criteria were not met (34.0%). However, ED providersobtained non-indicated CTs in 23.1% of patients. Less than 2% of the sample did not receive a headCT when imaging was indicated by NEXUS II.

Conclusion: ED providers in our sample had variable adherence to the Choosing Wisely head-CTrecommendation, especially for patients who did not meet the NEXUS II criteria. [West J EmergMed. 2017;18(5)821-829.]

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