ArticleBMC health services research2022
Ordering of computed tomography scans for head and cervical spine: a qualitative study exploring influences on doctors' decision-making.
Article in BMC health services research, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Rethinking Head Computed Tomography (CT) in the Emergency Department: From Reflex Imaging to Reasoned Care.Cureus · 2026Article
- Exploring Senior Emergency Physicians' Perspectives on the Inclusion of Clinical Biomarkers in Clinical Decision Rules for CT Head Use in Patients With Suspected Traumatic Brain Injury.Emergency medicine Australasia : EMA · 2025Article
- An analysis of disparities in imaging for suspected traumatic brain injury among patient visits to emergency departments (2010-2021).Frontiers in 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
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundOrdering of computed tomography (CT) scans needs to consideration of diagnostic utility as well as resource utilisation and radiation exposure. Several factors influence ordering decisions, including evidence-based clinical decision support tools to rule out serious disease. The aim of this qualitative study was to explore factors influencing Emergency Department (ED) doctors' decisions to order CT of the head or cervical spine.
methodsIn-depth semi-structured interviews were conducted with purposively selected ED doctors from two affiliated public hospitals. An interview tool with 10 questions, including three hypothetical scenarios, was developed and validated to guide discussions. Interviews were audio recorded, transcribed verbatim, and compared with field notes. Transcribed data were imported into NVivo Release 1.3 to facilitate coding and thematic analysis.
resultsIn total 21 doctors participated in semi-structured interviews between February and December 2020; mean interview duration was 35 min. Data saturation was reached. Participants ranged from first-year interns to experienced consultants. Five overarching emerging themes were: 1) health system and local context, 2) work structure and support, 3) professional practices and responsibility, 4) reliable patient information, and 5) holistic patient-centred care. Mapping of themes and sub-themes against a behaviour change model provided a basis for future interventions.
conclusionsCT ordering is complex and multifaceted. Multiple factors are considered by ED doctors during decisions to order CT scans for head or c-spine injuries. Increased education on the use of clinical decision support tools and an overall strategy to improve awareness of low-value care is needed. Strategies to reduce low-yield CT ordering will need to be sustainable, sophisticated and supportive to achieve lasting change.
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