Survey of patient and physician influences and decision-making regarding CT utilization for minor head injury.

Published

Journal Article

OBJECTIVE: Assess factors that influence both the patient and the physician in the setting of minor head injury in adults and the decision-making process around CT utilization. METHODS: This is a convenience sample survey study of adult minor head injury patients (GCS 15) and their physicians regarding factors influencing the decision to use CT to evaluate for intra-cranial haemorrhage. Once a head CT was ordered and before the results were known, both the patient and physician were given a one-page survey asking questions about their concern for injury and rationale for CT use. CT results and surveys were then recorded in a centralized database and analyzed. RESULTS: 584 subjects were enrolled over the 27-month study period. The rate of any intra-cranial haemorrhage was 3.3%. Both the physicians (6% pre-test estimate) and the patients (22% pre-test estimate) over-estimated risk for haemorrhage. Clinical decision rules were not met in 46% of cases where CT was used. Physicians listed an average of 5 factors from a list of 9 that influenced their decision to order CT. Patients listed an average of 1.7 factors influencing their decision to present to the Emergency Department for evaluation. Many patients felt cost (45%) and low risk stratification (34%) should weigh heavily in the decision to use CT. If asked to limit CT utilization, physicians were able to identify a group with less than 2% risk of injury. CONCLUSIONS: Patients with low risk of intra-cranial injury continue to be evaluated by CT. Physician decision-making around the use of CT to evaluate minor head injury is multi-factorial. Shared decision-making between the patient and the physician in a low risk minor head injury encounter shows promise as a method to reduce CT utilization in this low risk cohort.

Full Text

Duke Authors

Cited Authors

  • Quaas, J; Derrick, B; Mitrani, L; Baarbe, S; Yarusi, B; Wiener, D; Newman, D

Published Date

  • September 2014

Published In

Volume / Issue

  • 45 / 9

Start / End Page

  • 1503 - 1508

PubMed ID

  • 24929778

Pubmed Central ID

  • 24929778

Electronic International Standard Serial Number (EISSN)

  • 1879-0267

Digital Object Identifier (DOI)

  • 10.1016/j.injury.2014.05.012

Language

  • eng

Conference Location

  • Netherlands