Prevalence of Overuse of CT for Mild Head Injury in Phanatnikhom Hospital
Article Sidebar
Main Article Content
Abstract
BACKGROUND: Currently, a high number of brain computerized tomography (CT) scans are performed on patients with mild traumatic brain injuries (mTBI)., This leads to increased hospital expenses, without clear criteria to determine whether the use of this type of investigation is appropriate.
OBJECTIVES: To determine the prevalence of unnecessary brain computerized tomography scans and the associated factors in patients with mild traumatic brain injuries at Panatnikhom Hospital.
METHODS: This retrospective descriptive study included patients diagnosed with mild traumatic brain injuries classified as low to moderate risk between September 2022 and August 2023. The necessity of brain CT scans was assessed based on the Phanatnikhom Hospital Clinical Practice Guidelines for Traumatic Brain Injury. Univariable and multivariable analyses were used to identify the factors associated with unnecessary imaging.
RESULTS: Among the sample of 490 patients, the prevalence of unnecessary brain CT scans was 48.4%. However, only 10.6% of these unnecessary scans had an actual impact on patient management. The factors significantly associated with unnecessary brain CT scans included moderate risk classification of mild traumatic brain (p<0.001) and entitlement under the Road Accident Victims Protection Act (p=0.01).
CONCLUSIONS: Nearly half of the patients with mild traumatic brain injuries at Phanatnikhom Hospital received unnecessary brain CT scans. Application of clinical decision rules and awareness of relevant risk classification may help reduce unnecessary imaging and optimize resource utilization.
Thaiclinicaltrials.org number, TCTR20250515004
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Punjaisee S, Phuenpathom N, Veerasarn K, editors. Clinical practice guidelines for traumatic brain injury. Bangkok: Royal College of Surgeons of Thailand; 2013.
Phuenpathom N, Srikijvilaikul T, editors. Clinical practice guideline for traumatic brain injury. Bangkok: Royal College of Surgeons of Thailand; 2019.
Smith-Bindman R, Kwan ML, Marlow EC, Theis MK, Bolch W, Cheng SY, et al. Trends in use of medical imaging in US health care systems and in Ontario, Canada, 2000-2016. JAMA 2019;322:843-56.
Melnick ER, Szlezak CM, Bentley SK, Dziura JD, Kotlyar S, Post LA. CT overuse for mild traumatic brain injury. Jt Comm J Qual Patient Saf 2012;38:483-9.
Sakkas A, Weiß C, Wilde F, Ebeling M, Scheurer M, Thiele OC, et al. Justification of indication for cranial CT imaging after mild traumatic brain injury according to the current national guidelines. Diagnostics (Basel) [Internet]. 2023 [cited 2024 Aug 27];13(11):1826. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10252326/pdf/diagnostics-13-01826.pdf
Al Omran B, Patil JD, Anala A, Menezes P, Ahmed N, Cheffi I, et al. Prevalence of computed tomography overuse for mild head injury in adults. Cureus [Internet]. 2023 [cited 2024 Sep 6];15(2):e35551. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10058578/pdf/cureus-0015-00000035551.pdf
Saran M, Arab-Zozani M, Behzadifar M, Gholami M, Azari S, Bragazzi NL, et al. Overuse of computed tomography for mild head injury: a systematic review and meta-analysis. PLoS One [Internet]. 2024[cited 2024 Aug 26];19(1):e0293558. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10783716/pdf/pone.0293558.pdf
Klang E, Beytelman A, Greenberg D, Or J, Guranda L, Konen E, et al. Overuse of head CT examinations for the investigation of minor head trauma: analysis of contributing factors. J Am Coll Radiol 2017;14:171-6.
Champueng P. Factors associated with intracranial hemorrhage in mild traumatic brain injury patients with moderate risk at King Narai hospital. Singburi Hospital Journal 2021;30(2):1-13.
Pinyochotiwong P. CT brain imaging in mild traumatic brain injury; is hospital admission necessary? Journal of Medicine Region 4-5 2022;41(2):123–32.
