UMEM Educational Pearls

Title: Can we decrease CT utilization in mild TBI?

Category: Neurology

Keywords: clinical decision support, clinical decision rules, head CT, mild traumatic brain injury (PubMed Search)

Posted: 12/10/2014 by WanTsu Wendy Chang, MD
Click here to contact WanTsu Wendy Chang, MD

Does clinical decision support help reduce head CT utilization in mild traumatic brain injury related ED visits?

Mild traumatic brain injury (mTBI) account for approximately 1.2 million outpatient visits per year
Almost 1 million of these mTBI patients undergo head CT as part of their evaluation
Less than 6% have significant intracranial injuries that require neurosurgical intervention

Are we utilizing clinical decision rules adequately to help us appropriately select patients for CT imaging?

Can clinical decision support (CDS) help us reduce head CT utilization in mTBI related ED visits?

A recent study by Ip et al. reported on the use of a real-time computerized CDS in an EMR/CPOE system to provide feedback to an ordering provider on "low utility" CT's based on clinical decision rules (New Orleans Criteria, Canadian CT Head Rule, CT in Head Injury Patients Prediction Rule)
Over a 2 year period, 1221 of 1988 (64%) of mTBI related ED visits were associated with a head CT being performed
A 13.4% decrease in CT utilization was seen in the CDS intervention group (58.1% pre- vs. 50.3% post-, p=0.005)
A control cohort using the National Hospital Ambulatory Medical Care Survey (NHAMCS) as a representative of emergency medical care delivered in the U.S. showed no significant change in CT utilization in the same time period (73.3% pre- vs. 76.9% post-, p=0.272)

Take Home Point:

Clinical decision support may be a useful tool to help reduce CT utilization in mild TBI related ED visits.

References

Ip IK, Raja AS, Gupta A, et al. Impact of clinical decision support on head CT use in patients with mild traumatic brain injury in the emergency department. Am J Emerg Med 2014; Nov 13 [epub ahead of print]

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