DeAngelis John, Lou Valerie, Li Timmy, Tran Henry, Bremjit Praneeta, McCann Molly, Crane Peter, Jones Courtney M C
University of Rochester Medical Center, Department of Emergency Medicine, Rochester, New York.
Cambridge Health Alliance, Department of Emergency Medicine, Cambridge, Massachusetts.
West J Emerg Med. 2017 Aug;18(5):821-829. doi: 10.5811/westjem.2017.6.33685. Epub 2017 Jul 12.
The Choosing Wisely campaign currently recommends avoiding computed tomography (CT) of the head in low-risk emergency department (ED) patients with minor head injury, based on validated decision rules. However, the degree of adherence to this guideline in clinical practice is unknown. The objective of this study was to evaluate adherence to the Choosing Wisely campaign's recommendations regarding head CT imaging of patients with minor head injury in the ED.
We conducted a retrospective cohort study of adult ED patients at a Level I trauma center. Patients aged ≥ 18 years who presented to the ED with minor head injury were identified via International Classification of Diseases, 9th Revision, Clinical Modification codes. Medical record abstraction was conducted to determine the presence of clinical symptoms of the NEXUS II criteria, medical resource use, and head CT findings. We used descriptive statistics to characterize the study sample, and proportions were used to quantify guidelines adherence.
A total of 489 subjects met inclusion criteria. ED providers appropriately applied the Choosing Wisely criteria for 75.5% of patients, obtaining head CTs when indicated by the NEXUS II rule (41.5%), and not obtaining head CTs when the NEXUS II criteria were not met (34.0%). However, ED providers obtained non-indicated CTs in 23.1% of patients. Less than 2% of the sample did not receive a head CT when imaging was indicated by NEXUS II.
ED providers in our sample had variable adherence to the Choosing Wisely head-CT recommendation, especially for patients who did not meet the NEXUS II criteria.
“明智选择”运动目前建议，根据经过验证的决策规则，对于低风险急诊科（ED）中轻度头部受伤的患者，避免进行头部计算机断层扫描（CT）。然而，临床实践中对该指南的遵循程度尚不清楚。本研究的目的是评估急诊科中轻度头部受伤患者对“明智选择”运动关于头部CT成像建议的遵循情况。
我们对一家一级创伤中心的成年急诊科患者进行了一项回顾性队列研究。通过国际疾病分类第九版临床修订本代码识别出年龄≥18岁且因轻度头部受伤就诊于急诊科的患者。进行病历摘要以确定是否存在NEXUS II标准的临床症状、医疗资源使用情况以及头部CT检查结果。我们使用描述性统计来描述研究样本，并使用比例来量化指南遵循情况。
共有489名受试者符合纳入标准。急诊科医护人员对75.5%的患者正确应用了“明智选择”标准，在NEXUS II规则表明需要时进行头部CT检查（41.5%），在不符合NEXUS II标准时不进行头部CT检查（34.0%）。然而，急诊科医护人员在23.1%的患者中进行了非必要的CT检查。当NEXUS II表明需要成像时，样本中不到2%的患者未接受头部CT检查。
我们样本中的急诊科医护人员对“明智选择”头部CT建议的遵循情况各不相同，尤其是对于不符合NEXUS II标准的患者。
