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Head Injury Decision Support Tool Modestly Lowers CT Use in EDs

The Canadian CT Head Rule (CCHR) was developed to help physicians determine which minor head injury patients require expensive computed tomography imaging.

A new study published recently in the Annals of Emergency Medicine examined the success of the decision support tool when implemented in U.S. emergency departments. Kaiser Permanente researchers found that CCHR both reduced use of the imaging and improved identification of injuries in adult trauma patients.

Lead author Adam L. Sharp MD, MS, an emergency physician with the Kaiser Permanente Southern California Department of Research & Evaluation, explained that the aims of the study were to decrease unneeded CT scans that drive costs up and may harm patients, and also to ensure that patients are receiving the highest quality care.

Study authors point out that the intervention had several essential elements:

  • clinical leadership endorsement;
  • physician education through an e-learning module;
  • a clinical decision support tool embedded into the electronic health record.

The research focused on 43,053 adult trauma patients presenting to 13 Kaiser Permanente community EDs in Southern California from January 2014 to December 2015. The racially diverse participants had an average age of 59, with a slight majority of women.

Head CT was provided to 31.1% of the adult trauma patients, but that represented a 5.3% reduction in CT use and an increase in CT-identified injuries, researchers note. After the intervention, diagnostic accuracy in identifying intracranial injuries with CT increased by 2.3%, the study points out.

All but one of the EDs in the study lowered use of head CT following the implementation of the intervention; the outlier posted a 0.3% increase.

“A multicomponent implementation of the Canadian CT Head Rule was associated with a modest reduction in CT use and an increased diagnostic yield of head CTs for adult trauma encounters in community EDs,” study authors conclude.