2 results
P099: Age related rates of abnormal CT findings in otherwise low risk minor head injury patients over 65
- B.A. Parker, M. Ertel, J. Angel-Mira, P. Brar, D. James, M. Cheyne, N. Kandola, R. Brar, H. Sidhu, B. Evtushevski
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 19 / Issue S1 / May 2017
- Published online by Cambridge University Press:
- 15 May 2017, pp. S111-S112
- Print publication:
- May 2017
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- Article
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Introduction: The Canadian CT Head Rules (CCTHR) is the gold standard clinical decision rule for minor head injuries (MHIs) & has been shown to have 100% sensitivity in identifying patients that would have an abnormal CT scan. Within the CCTHR age 65+ is considered to be an independent risk factor for abnormal head CT. However, a previously published Italian study indicated that the rate of pathological findings in otherwise low risk MHI patients under the age of 79 was less than 1% & significantly lower than those over the age of 80, which brings to question whether the traditional age cut off of 65 as a factor in the CCTHR is too conservative when considering the appropriateness for imaging. Therefore this study aimed to quantify the extent to which low risk MHI patients between the ages of 65-79 present with abnormal CT findings or require neurosurgical intervention when compared to patients over 80 years of age as one of the criteria used in the CCTHR is the age threshold of 65. A secondary objective of this study was to explore abnormal CT rates across these age groupings for otherwise low risk patients on anticoagulants. Methods: A retrospective chart review was conducted on all patients over the age of 65 that received a head CT for a MHI in the Kelowna General Hospital ED between 2006-2016. The imaging results for all patients that had no other risk criteria of the CCTHR other than age were reviewed & rates of pathological findings were compared between patients ages 65-79 & 80+ for both patients on anticoagulants & those not on anticoagulants. Differences in rates by age were compared for statistical significance using the chi-squared & Fisher’s exact test. Results: To date 248 patients have been reviewed & meet the criteria of being >65 & with no other CCTHR criteria. 65% of patients were female & 30% of patients were on anticoagulants. For the patients that were not on anticoagulants, 6 of the 75 (8%) individuals between 65-79 & 9 of the 94 (10%) of those over 80 had abnormal findings on CT (p=0.128). Conclusion: Preliminary results of this study population indicate that there are a significant number of abnormal CT findings in patients under the age of 80 suggesting that patients ages 65-79 without any other CCTHR criteria may still benefit from a head CT. Chart reviews are ongoing & updated results including findings for anti-coagulated patients will be presented at CAEP 2017.
P051: Does knowledge of the Canadian CT Head Rules impact the frequency of CT’s ordered?
- H.C. Duyvewaardt, M. Ertel, J. Angel-Mira, B. Parker, N. Kandola, M. Cheyne, R. Brar, H. Sidhu
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 19 / Issue S1 / May 2017
- Published online by Cambridge University Press:
- 15 May 2017, p. S95
- Print publication:
- May 2017
-
- Article
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- You have access Access
- Export citation
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Introduction: The Canadian Computed Tomography Head Rules (CCTHR) is a validated and well-known head injury clinical decision rule that allows Emergency Room Physicians (ERPs) to determine which patients are most likely to benefit from a diagnostic CT. However, this clinical decision rule is not uniformly adhered to and a number of preventable CT scans are ordered. Choosing Wisely Canada has ranked decreasing unnecessary head CT scans as the number one priority for Emergency Departments (ED). As such, the purpose of this study was to investigate if an educational intervention for ERPs would increase adherence to the CCTHR. Methods: In September 2015 the CCTHR were presented and discussed at three ED departmental meetings at Kelowna General Hospital (KGH) a large tertiary hospital in the interior of British Columbia, Canada. Educational materials were distributed to the ERPS and a CTTHR checklist was made available throughout the ED. Rates of adherence to the CCTHR criteria were calculated from MHI patients that were seen in the four years prior to the educational intervention and were compared to rates of adherence for patients 12 months post educational intervention. Only patients that agreed to participate in the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) were included in this analysis. Differences in adherence rates were tested using the chi-squared test. Results: 477 patients were included in the analysis for the pre-education cohort (control) and 257 for the post-education cohort(intervention). In the control cohort, 348 of the 477 (73%) of the patients were managed in accordance to the CCTHR compared to 194 of the 257 (75%) in the intervention cohort. There was no statistically significant difference in rates of adherence (p=0.457).In the control cohort, 44 of the 321 (14%) of patients received a CT that did not meet any CCTHR criteria compared to 15 of the 163 (9%) in the intervention cohort. The overall CT imaging rate was 24% in each patient cohort. Conclusion: Although adherence rates between the two cohorts were not statistically different, a greater proportion of patients had a CTAS of 2 or 3 and met criteria in the intervention cohort suggesting a higher level of acuity. Imaging rates remained constant at 24%, which was lower than expected if there was full adherence to the CCTHR. Further study is required to determine if educational interventions can improve adherence to the CCTHR.