title: Attitudes toward evidence-based clinical decision support tools to reduce exposure to ionizing radiation: The Canadian CT Head Rule.
abstract: OBJECTIVE
  A large degree of variation in clinical practice exists among clinicians evaluating and treating individuals with minor head injuries. Noncontrast head computerized tomography (CT) scans are commonly used to assess for intracranial damage in patients presenting with head injury. This practice is not supported by the evidence and poses harm to patients by increasing exposure to ionizing radiation. This form of radiation exposure increases the risk of developing cancers over the course of the individual's life, and further strains the limited resources of the healthcare system.
  This article describes the findings of an evidence-based practice project assessing the attitudes of clinicians toward an evidence-based clinical decision support tool (Canadian CT Head Rule [CCHR]). The CCHR has 100% sensitivity in detecting all clinically important brain injuries and any injury requiring neurosurgical intervention. This clinical decision support (CDS) tool is designed to help guide clinicians in the prudent use of head CT scans in people ages 16-64 that have sustained minor head injuries. The Evidence-Based Attitude Scale was also used to identify which domains were most influential on willingness to adopt into clinical practice.
  
  
  CONCLUSIONS
  The results revealed an 84% increase in clinician knowledge of the use of the CCHR. A majority (83%) of participants reported moderate likelihood of adoption of the CDS tool into clinical practice if they found the tool appealing, and it was required by a governing authority. The use of CDS tools can help healthcare providers mitigate the risk associated with caring for complex patients. CDS tools provide a systematic method to evaluate patients with minor head injuries while assuring consistency of care and quality outcomes. This practice of assuring consistency and good patient outcomes is foundational to the concept of standard of care, which serves to improve clinical practice.
authors.affiliation: New York Presbyterian Hospital-Payne Whitney Clinic, New York, NY.
authors.forename: Raymond
authors.initials: R
authors.lastname: Zakhari
authors.affiliation: Chatham University, Pittsburgh, PA.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Sterrett
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D020000:Decision Support Systems, Clinical / Q000295:instrumentation / Q000592:standards*; D055317:Evidence-Based Practice / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D058996:Quality Improvement; D000069079:Radiation Exposure / Q000517:prevention & control*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*
keywords: Clinical practice guidelines; clinical decision-making; evidence-based practice; traumatic brain injury