High-yield referral criteria for posttraumatic skull roentgenography. Response of physicians and accuracy of criteria.
We evaluated a list of high-yield criteria (HYL) as a means of reducing posttraumatic skull roentgenograms and as a diagnostic test for skull fractures. Physicians requested roentgenograms for 76.9% of head trauma patients in a four-month control period, but for only 46.1% during a four-month experimental period, a relative decrease of 40%. When the experiment ended, roentgenogram use increased to 72% of head trauma patients. The HYL accurately classified 92.5% of the patients with and 84.5% of the patients without pathological conditions. The HYL displayed substantial differences in sensitivity and specificity from HYLs used previously. Clinicians disliked the HYL, believing it was inaccurate and a monitoring device. We conclude that criteria lists can effectively decrease requests for roentogenograms and should be carefully evaluated as diagnostic tests for accuracy and adverse outcomes.
D003211:Concurrent Review; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging*; D006296:Health Services; D006300:Health Services Misuse; D006744:Hospital Bed Capacity, 100 to 299; D006801:Humans; D009460:Neurologic Examination; D010808:Physical Examination; D011859:Radiography; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012886:Skull / Q000000981:diagnostic imaging*; D012887:Skull Fractures / Q000000981:diagnostic imaging*; D014600:Utilization Review; D014861:Washington