Growing number of emergency cranial CTs in patients with head injury not justified by their clinical need.
BACKGROUND
Computed tomography (CT) is widely available in most hospitals, usually 24 h a day, which results in an expansion of its indications, sometimes beyond medically justifiable extent.


OBJECTIVE
To evaluate trends in emergency cranial CTs in a general university hospital during the last 15 years.


METHODS
We conducted a database search for emergency cranial CTs between January 2000 and December 2015 that were performed in patients after head injury on weekends and bank holidays and between 8 P.M. and 6 A.M. on workdays. The numbers were compared with demographic data, the number of hospital beds, and total number of CT examinations.


RESULTS
The annual number of emergency cranial CTs increased 5.5 times from 124 to 679 with a sharp increase since 2013. This trend showed a negative correlation with the number of hospital beds (r = -0.88, p = 0.0001), the proportion of important findings on cranial CT (r = -0.74, p = 0.0010), or the proportion of patients indicated for cranial CT by NICE 2014 criteria (r = -0.90, p < 0.0001) and positive correlation with the proportion of inebriated patients (r = 0.94, p < 0.0001), and their average GCS score (r = 0.92, p < 0.0001). Compared to the number of emergency cranial CTs, the slope of regression lines for all trends was significantly different (p < 0.001) apart from the number of inebriated patients (p = 0.062).


CONCLUSIONS
The increase in the emergency cranial CTs cannot be entirely justified by their clinical need. We assume that this is the result of an absent support of adherence to the guidelines in the legislation together with a medicolegally unpredictable environment.
Department of Radiology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 12808, Prague, Czech Republic. lambert.lukas@gmail.com.
Lukas
L
Lambert
Department of Surgery, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
Ondrej
O
Foltan
Department of Surgery, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
Jan
J
Briza
Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
Alena
A
Lambertova
Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
Pavel
P
Harsa
Department of Radiology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 12808, Prague, Czech Republic.
Rohan
R
Banerjee
Department of Radiology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 12808, Prague, Czech Republic.
Jan
J
Danes
D039602:After-Hours Care / Q000706:statistics & numerical data; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D018153:Czech Republic / Q000453:epidemiology; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D014600:Utilization Review
Computed tomography; Emergency; Head; Trauma; Trend