title: Adherence to head computed tomography guidelines for mild traumatic brain injury.
abstract: BACKGROUND
  Traumatic brain injury (TBI) is a significant health concern. While 70-90% of TBI cases are considered mild, decision-making regarding imaging can be difficult. This survey aimed to assess whether clinicians' decision-making was consistent with the most recent American College of Emergency Physicians (ACEP) clinical recommendations regarding indications for a non-contrast head computed tomography (CT) in patients with mild TBI.
  
  
  METHODS
  We surveyed 2 academic emergency medicine departments. Six realistic clinical vignettes were created. The survey software randomly varied 2 factors: age (30, 59, or 61 years old) and presence or absence of visible trauma above the clavicles. A single important question was asked: "Would you perform a non-contrast head CT on this patient?"
  
  
  RESULTS
  Physician decision-making was consistent with the guidelines in only 62.8% of total vignettes. By age group (30, 59, and 61), decision-making was consistent with the guidelines in 66.7%, 47.4%, and 72.7% of cases, respectively. This was a statistically-significant difference when comparing the 59- and 61-year-old age groups. In the setting of presence/absence of trauma above the clavicles, respondents were consistent with the guidelines in 57.1% of cases. Decision-making consistent with the guidelines was significantly better in the absence of trauma above the clavicles.
  
  
  CONCLUSIONS
  Respondents poorly differentiated the "older" patients from one another, suggesting that respondents either inappropriately apply the guidelines or are unaware of the recommendations in this setting. No particular cause for inconsistency could be determined, and respondents similarly under-scanned and over-scanned in incorrect vignettes. Improved dissemination of the ACEP clinical policy and recommendations is a potential solution to this problem.
authors.affiliation: Department of Emergency Medicine, SUNY Upstate Medical University, Syracuse, New York.
authors.forename: Landon A
authors.initials: LA
authors.lastname: Jones
authors.affiliation: Department of Emergency Medicine, Stony Brook University Medical Center, Stony Brook, New York.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Morley
authors.affiliation: Department of Emergency Medicine, SUNY Upstate Medical University, Syracuse, New York.
authors.forename: William D
authors.initials: WD
authors.lastname: Grant
authors.affiliation: Department of Emergency Medicine, SUNY Upstate Medical University, Syracuse, New York.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Wojcik
authors.affiliation: Department of Emergency Medicine, SUNY Upstate Medical University, Syracuse, New York.
authors.forename: William F
authors.initials: WF
authors.lastname: Paolo
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000000981:diagnostic imaging*; D003657:Decision Making; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed / Q000592:standards*