title: Survey of patient and physician influences and decision-making regarding CT utilization for minor head injury.
abstract: OBJECTIVE
  Assess factors that influence both the patient and the physician in the setting of minor head injury in adults and the decision-making process around CT utilization.
  
  
  METHODS
  This is a convenience sample survey study of adult minor head injury patients (GCS 15) and their physicians regarding factors influencing the decision to use CT to evaluate for intra-cranial haemorrhage. Once a head CT was ordered and before the results were known, both the patient and physician were given a one-page survey asking questions about their concern for injury and rationale for CT use. CT results and surveys were then recorded in a centralized database and analyzed.
  
  
  RESULTS
  584 subjects were enrolled over the 27-month study period. The rate of any intra-cranial haemorrhage was 3.3%. Both the physicians (6% pre-test estimate) and the patients (22% pre-test estimate) over-estimated risk for haemorrhage. Clinical decision rules were not met in 46% of cases where CT was used. Physicians listed an average of 5 factors from a list of 9 that influenced their decision to order CT. Patients listed an average of 1.7 factors influencing their decision to present to the Emergency Department for evaluation. Many patients felt cost (45%) and low risk stratification (34%) should weigh heavily in the decision to use CT. If asked to limit CT utilization, physicians were able to identify a group with less than 2% risk of injury.
  
  
  CONCLUSIONS
  Patients with low risk of intra-cranial injury continue to be evaluated by CT. Physician decision-making around the use of CT to evaluate minor head injury is multi-factorial. Shared decision-making between the patient and the physician in a low risk minor head injury encounter shows promise as a method to reduce CT utilization in this low risk cohort.
authors.affiliation: Department of Emergency Medicine, St. Luke's-Roosevelt Hospital, New York, NY, United States. Electronic address: quaa0005@umn.edu.
authors.forename: Joshua
authors.initials: J
authors.lastname: Quaas
authors.affiliation: Department of Emergency Medicine, Duke University Medical Center, Durham, NC, United States.
authors.forename: Bruce
authors.initials: B
authors.lastname: Derrick
authors.affiliation: Department of Emergency Medicine, St. Luke's-Roosevelt Hospital, New York, NY, United States.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Mitrani
authors.affiliation: Department of Emergency Medicine, St. Luke's-Roosevelt Hospital, New York, NY, United States.
authors.forename: Simon
authors.initials: S
authors.lastname: Baarbe
authors.affiliation: Department of Emergency Medicine, St. Luke's-Roosevelt Hospital, New York, NY, United States.
authors.forename: Brett
authors.initials: B
authors.lastname: Yarusi
authors.affiliation: Department of Emergency Medicine, St. Luke's-Roosevelt Hospital, New York, NY, United States.
authors.forename: Dan
authors.initials: D
authors.lastname: Wiener
authors.affiliation: Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY, United States.
authors.forename: David
authors.initials: D
authors.lastname: Newman
mesh_terms: D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging*; D003657:Decision Making; D003661:Decision Support Techniques; D015600:Glasgow Coma Scale; D006801:Humans; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging*; D057240:Patient Preference / Q000706:statistics & numerical data*; D010820:Physicians / Q000706:statistics & numerical data*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000009:adverse effects* / Q000706:statistics & numerical data; D014481:United States
keywords: CAT scan (computed tomography); Minor head injury; Radiographic utilization; Risk assessment; Shared decision-making