Is routine computed tomography scanning too expensive for mild head injury?
OBJECTIVE
To compare relative costs of treating mildly head-injured patients by routine admission or by using skull radiographs or cranial computed tomography (CT) scanning to screen patients for admission.


METHODS
Retrospective record review, hypothetical costs based on actual patient course and requirements.


METHODS
Southern New Jersey Regional Trauma Center at Cooper Hospital/University Medical Center.


METHODS
658 consecutive mildly head-injured patients admitted from 1986 to 1988. All were given cranial CT scans.


METHODS
Records were reviewed retrospectively and hypothetical costs were calculated based on actual length of hospitalization, surgical intervention, etc. These costs were compared for different treatment protocols.


RESULTS
The average cost if every patient had been admitted for observation given skull radiographs, with CT scans done on those exhibiting skull fracture or later deterioration, was $1,207. If the CT scan had been used to identify patients with intracranial lesions and the others had been discharged, costs would have been almost 10% less. Had skull radiography been used to screen admissions, costs would have been 22% below those of routine CT scanning. However, these small savings are likely to be reduced by additional expenses related to missed intracranial lesions.


CONCLUSIONS
Every patient with loss of consciousness or post-traumatic amnesia should have routine CT scanning. If the scan is normal and there are no other reasons for admission, the patients can be discharged safely from the emergency department. This represents optimal care from a medical standpoint and is justified from a cost-effectiveness point of view.
Stein
S C
SC
Department of Surgery, Cooper Hospital/University Medical Center, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Camden.
O'Malley
K F
KF
Ross
S E
SE
D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000000981:diagnostic imaging; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D006259:Craniocerebral Trauma / Q000145:classification / Q000000981:diagnostic imaging* / Q000191:economics; D015600:Glasgow Coma Scale; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D012887:Skull Fractures / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000191:economics*