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When Costly and Potentially Harmful CT Scans Are Not Necessary

Key Finding and Impact:

Giving clinicians the tools to support patient-provider communication could result in fewer CTs ordered, higher physician trust, and higher patient knowledge in cases involving minor head injuries.

Is that CT scan in the patient’s best interest?

While the increased use of diagnostic imaging tests like CT has outpaced healthcare growth, the use of these tests does not always reflect patient-centered care. Frequently overused in the ED setting, CT scans are often ordered in scenarios where there is no evidence of improved patient outcomes. Additionally, non-essential CT scans can result in increased healthcare costs, exposure to unnecessary radiation, and longer hospital stays.

Aligning best practices for CT scans for patients with minor head injuries.

“About 1 out of every 3 CT scans that are performed in the ER for minor head injury are not clinically indicated.”
- Dr. Edward Melnick

Dr. Edward Melnick and his research team at Yale University sought to identify the non-clinical, human factors that promote or inhibit the appropriate use of CT in patients presenting to the ED with minor head injury. They talked to patients and providers to inform the development of the Concussion or Brain Bleed application (integrated patient- and provider-facing app), an innovative CDS tool that integrated a patient-centered decision aid and CDS at the bedside for the management of minor head injury in the ED. The app was based on the Canadian Computed Tomography Head Rule (CCTHR), a clinical decision rule designed and validated to safely reduce imaging in minor head injury.

Sorry, Doctor, did you say I don’t need a CT?

The team’s overall goal was to better prepare clinicians to guide patients with minor head injuries on appropriate CT use and to evaluate the tool through a pilot study. When physicians expressed empathy and had increased knowledge of when CT use was appropriate, patients accepted the recommended treatment, even when not utilizing advanced imaging like CT scan. While development of CDS for minor head injuries increased the likelihood of clinically appropriate CT, implicit in this process is the time spent with the patient to assure they understand and are comfortable with a treatment plan that does not involve CT.

Research Details

Principal Investigator: Melnick, Edward
Organization: Yale University