Reasons for ordering computed tomography scans of the head in patients with minor brain injury - Rohacek, M.; Albrecht, M.; Kleim, B.; Zimmermann, H.; Exadaktylos, A. (Injury, 2012)
BACKGROUND: Minor brain injury is a frequent condition. Validated clinical decision rules can help in deciding whether a computed tomogram (CT) of the head is required. We hypothesized that institutional guidelines are not frequently used, and that psychological factors are a common reason for ordering an unnecessary CT. METHODS: Physicians at the emergency department of a tertiary care hospital completed an anonymous questionnaire before ordering a CT of the head for a patient presenting with a GCS of 13-15 after a head trauma. RESULTS: Over a period of 10 months, 1018 CTs of the head were performed in patients presenting with a GCS of 13-15 after a head trauma; 168 (16.5%) questionnaires were completed. The most four common reasons for ordering a CT were "to confirm/rule out traumatic intracranial lesion" (in 94% of all questionnaires), "to expedite diagnosis" (63%) "guidelines" (58%) and "fear of missing a traumatic intracranial lesion" (50%). A positive answer for "fear of being sued" was declared in 21%, and "pressure from the patient or his relatives" in 8% of all questionnaires. Of 71 questionnaires without "guidelines" as a positive answer, there were 40 (56%) positive answers of "fear of missing a traumatic cerebral lesion". CONCLUSION: Besides guidelines, fear of missing a traumatic intracranial lesion played a role in ordering head CTs. Although the physicians had been instructed in the use of guidelines, including validated clinical decision rules, this did not prevent them from ordering unnecessary CTs.
Keywords: journalArticle; *Practice Patterns, Physicians'/standards; Adolescent; Adult; Aged; Aged, 80 and over; Brain Injuries/*diagnostic imaging/etiology; Brain/*diagnostic imaging; Craniocerebral Trauma/complications/*diagnostic imaging; Decision Making; Female; Glasgow Coma Scale; Guideline Adherence/*statistics & numerical data; Humans; Male; Middle Aged; Practice Guidelines as Topic; Switzerland; Tertiary Healthcare; Tomography, X-Ray Computed/*statistics & numerical data; Unnecessary Procedures; Young Adult