ArticleLa Radiologia medica2018
Overuse of computed tomography for minor head injury in young patients: an analysis of promoting factors.
Article in La Radiologia medica, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 2 of them syntheses that pooled it.
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Who cites it
14 citing papers in PubMed, 2 syntheses or guidelines pooled it, 32 citations in OpenAlex.
- Overutilization of head computed tomography in cases of mild traumatic brain injury: a systematic review and meta-analysis.Emergency radiology · 2024Pooled it
- Overuse of computed tomography for mild head injury: A systematic review and meta-analysis.PloS one · 2024Pooled it
- The role of two brain injury biomarkers, GFAP and UCH-L1, for the management of mTBI in the Emergency Department: an observational study.Internal and emergency medicine · 2026Observational
- Frequency of Abnormal CT Scans and the Correlation with Patients Complaints in Emergency Department.Iranian journal of child neurology · 2025Article
- Understanding the factors that influence CT utilization for mild traumatic brain injury in a low resource setting - a qualitative study using the Theoretical Domains Framework.African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2024Article
- Patterns of computed tomography utilisation in injury management: latent classes approach using linked administrative data in Western Australia.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2023Observational
- Deep Learning-Based Versus Iterative Image Reconstruction for Unenhanced Brain CT: A Quantitative Comparison of Image Quality.Tomography (Ann Arbor, Mich.) · 2023Article
- Does clinical decision support system promote expert consensus for appropriate imaging referrals? Chest-abdominal-pelvis CT as a case study.Insights into imaging · 2023Article
- Article
- Ordering of computed tomography scans for head and cervical spine: a qualitative study exploring influences on doctors' decision-making.BMC health services research · 2022Article
- Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review.BMC medical imaging · 2022Article
- Does implementation of the PECARN rules for minor head trauma improve patient-centered outcomes in a lower resource emergency department: a retrospective cohort study.BMC pediatrics · 2020Article
- Head CT scan in emergency room: Is it still abused? Quantification and causes analysis of overprescription in an Italian Emergency Department.La Radiologia medica · 2020Article
- Benefits of Low-Dose CT Scan of Head for Patients With Intracranial Hemorrhage.Dose-response : a publication of International Hormesis SocietyReview
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimTo assess the amount of computed tomography (CT) scans for minor head injury (MHI) performed in young patients in our emergency department (ED), not indicated by National Institute for Health and Clinical Excellence (NICE) and Canadian Computed Tomography Head Rules (CCHR), and to analyze factors contributing to unnecessary examinations. Secondary objectives were to calculate the effective dose, to establish the number of positive CT and to analyze which of the risk factors are correlated with positivity at CT; finally, to calculate sensitivity and specificity of NICE and CCHR in our population. MATERIALS AND
methodsWe retrospectively evaluated 493 CT scans of patients aged 18-45 years, collecting the following parameters from ED medical records: patient demographics, risk factors indicating the need of brain imaging, trauma mechanism, specialty and seniority of the referring physician. For each CT, the effective dose and the negativity/positivity were assessed.
results357/493 (72%) and 347/493 (70%) examinations were not in line with the CCHR and NICE guidelines, respectively. No statistically significant difference between physician specialty (p = 0.29 for CCHR; p = 0.24 for NICE), nor between physician seniority and the amount of inappropriate examinations (p = 0.93 for CCHR, p = 0.97 for NICE) was found but CT scans requested by ED physicians were less inappropriate [p = 0.28, odds ratio (OR) 0.562, CI (95%) 0.336-0.939]. There was no statistically significant correlation between patient age and over-referral (p = 0.74 for NICE, p = 0.93 for CCHR). According to NICE, low speed motor vehicle accident (p = 0.009), motor vehicle accident with high energy impact (p < 0.01) and domestic injuries (p = 0.002) were associated with a higher rate of unwarranted CT; according to CCHR only motor vehicle accident with high energy impact showed a significant correlation with unwarranted CT scan (p < 0.001, OR 44.650, CI 33.123-1469.854). 2% of CT was positive. Multivariate analysis demonstrated that factors significantly associated with CT scan positivity included signs of suspected skull fracture (p < 0.001, OR 20.430, CI 2.727-153.052) and motor vehicle accident with high energy impact (p < 0.001, OR 220.650, CI 33.123-1469.854). In our series, CCHR showed sensitivity of 100%, specificity of 74%; NICE showed sensitivity of 100%, specificity of 72%.
conclusionWe observed an important overuse of head CT scans in MHI; the main promoting factor for inappropriate was injury mechanism. 2% of head CT were positive, correlating with signs of suspected skull fracture and motor vehicle accident with high energy impact.
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