Is routine computed tomography scanning too expensive for mild head injury?

OBJECTIVE

To compare relative costs of treating mildly head-injured patients by routine admission or by using skull radiographs or cranial computed tomography (CT) scanning to screen patients for admission.

DESIGN

Retrospective record review, hypothetical costs based on actual patient course and requirements.

SETTING

Southern New Jersey Regional Trauma Center at Cooper Hospital/University Medical Center.

PARTICIPANTS

658 consecutive mildly head-injured patients admitted from 1986 to 1988. All were given cranial CT scans.

MEASUREMENTS

Records were reviewed retrospectively and hypothetical costs were calculated based on actual length of hospitalization, surgical intervention, etc. These costs were compared for different treatment protocols.

MAIN RESULTS

The average cost if every patient had been admitted for observation given skull radiographs, with CT scans done on those exhibiting skull fracture or later deterioration, was $1,207. If the CT scan had been used to identify patients with intracranial lesions and the others had been discharged, costs would have been almost 10% less. Had skull radiography been used to screen admissions, costs would have been 22% below those of routine CT scanning. However, these small savings are likely to be reduced by additional expenses related to missed intracranial lesions.

CONCLUSIONS

Every patient with loss of consciousness or post-traumatic amnesia should have routine CT scanning. If the scan is normal and there are no other reasons for admission, the patients can be discharged safely from the emergency department. This represents optimal care from a medical standpoint and is justified from a cost-effectiveness point of view.