Implementation of a guideline for computed tomography head imaging in head injury: a prospective study.
OBJECTIVE
To improve appropriate ordering of head computed tomography (CT) in patients presenting with a head injury by applying an evidence-based head injury guideline.


METHODS
This was a comparison observational study of CT head ordering in the setting of head trauma between two groups of patients. There was a pre-guideline implementation group and a post-guideline implementation group. Our Southernhealth Head Injury Guideline was largely based on the Canadian CT Head Rule by Steill et al. 2001.We also applied the Canadian CT Head Rule to our post-guideline implementation group.


RESULTS
CT ordering rate in the pre-guideline group was 31.6% compared with 59% in the post-guideline group with a relative risk of 1.88 (95% confidence interval [CI]: 1.56-2.27). Abnormal head CT were reported in 6.8% in the pre-guideline group and 5% in the post-guideline group (relative risk 0.88, 95% CI 0.44-1.51). When we applied the Canadian CT Head Rule to the prospective group, four patients with clinically significant abnormal head CT would not have been scanned. The sensitivity of the guideline was 100% (95% CI 79-100%), with a specificity of 43.22% (95% CI 37-48%) in diagnosing a significant head injury on CT.


CONCLUSIONS
The Southernhealth Head Injury Guideline is safe and easy to apply to minor and major head injuries.
Fong
Christina
C
Monash Medical Centre, Southernhealth Care, Clayton, Victoria, Australia. christina.fong@southernhealth.org.au
Chong
Winston
W
Villaneuva
Elmer
E
Segal
Ahuva Yocheved
AY
D016001:Confidence Intervals; D006259:Craniocerebral Trauma / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000592:standards*; D014739:Victoria