Main Article Content
Brain CT-scan, Emergency, Neurology
Background:Inappropriate brain CTscan requesting in the emergency department imposes extra charges to the healthcare system and patients. Besides, unnecessary radiation exposure may cause irreparable damage to the patient. In this study, we investigated the percentage of inappropriately conducted brain CT scan for different chief complaints in non-traumatic patients presented to our emergency department.
Material and methods: 160 patients aged over 18 years old with chief complaints other than trauma, referred to the emergency department of Imam Hossein Hospital (Tehran, Iran), were enrolled in this study. Data were collected from medical records; the inclusion criteria were patients older than 18 years with chief complaint other than trauma.
Results:160 people aged 18 to 100 years old enrolled in this study, 83 (51.87%) were male and 77 (48.13%) were female. There was no statistically significant difference in terms of inappropriate brain CT between different age groups. Percentage of inappropriate CT according to chief complaints were as follows: 4.8% for dysarthria, 0% for right and left hemiplegia, 9.1% for a decreased level of consciousness, 30% for nausea and vomiting, 41.7% for generalized weaknesses, 0% for seizures, 55.6% for vertigo, 25% for headache, and 57.7% for other complaints. There was a statistically significant association between chief complaints and inappropriate brain CT scan requests (p-value = 0.001).
Conclusion:Considering the significant percentage of inappropriate brain CT scan requests for non-traumatic patients in the setting of the emergency department, it is critical for healthcare policymakers to propose practical guidelines and supervise their application.
2. Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 1: the content, quality, and accessibility of care. Annals of internal medicine. 2003;138(4):273-87.
3. Childs AW, Hunter ED. Non-medical factors influencing use of diagnostic x-ray by physicians. Medical Care. 1972:323-35.
4. Levin DC, Rao VM. Turf wars in radiology: the overutilization of imaging resulting from self-referral. Journal of the American College of Radiology. 2004;1(3):169-72.
5. Hillman BJ, Joseph CA, Mabry MR, Sunshine JH, Kennedy SD, Noether M. Frequency and costs of diagnostic imaging in office practice—a comparison of self-referring and radiologist-referring physicians. New England Journal of Medicine. 1990;323(23):1604-8.
6. Brenner DJ. Radiation risks potentially associated with low-dose CT screening of adult smokers for lung cancer. Radiology. 2004;231(2):440-5.
7. Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. New England Journal of Medicine. 2007;357(22):2277-84.
8. Medina LS, Kuntz KM, Pomeroy S. Children with headache suspected of having a brain tumor: a cost-effectiveness analysis of diagnostic strategies. Pediatrics. 2001;108(2):255-63.
9. Barzin M, Alaee A, Gholian Jooibari S. MRI findings in patients with headache referred to Imam Khomeini Hospital, Sari, Iran, fromOctober 2007 to February 2009. Journal of Mazandaran University of Medical Sciences. 2010;20(75):65-9.
10. Ahsan SF, Syamal MN, Yaremchuk K, Peterson E, Seidman M. The costs and utility of imaging in evaluating dizzy patients in the emergency room. The Laryngoscope. 2013;123(9):2250-3.
11. Mitsunaga MM, Yoon H-C. Journal Club: Head CT scans in the emergency department for syncope and dizziness. American Journal of Roentgenology. 2015;204(1):24-8.
12. Lehnert BE, Bree RL. Analysis of appropriateness of outpatient CT and MRI referred from primary care clinics at an academic medical center: how critical is the need for improved decision support? Journal of the American College of Radiology. 2010;7(3):192-7.