Appropriate CT cervical spine utilisation in the emergency department

Abstract

IntroductionOver 40 000 CT scans are performed in our emergency department (ED) annually and utilisation is over 80% capacity. Improving medical appropriateness of CT scans may reduce total number of scans, time, cost and radiation exposure.MethodsLean Six Sigma methodology was used to improve the process. A National Emergency X-Radiography Utilisation Study (NEXUS)-based PowerForm was implemented in the electronic health record and providers were educated on the criteria.ResultsThe rate of potentially medically inappropriate CT C-spine scans decreased from 45% (19/42) to 22% (90/403) (two-proportion test, p=0.002). After the intervention, there was no longer a difference between midlevel providers and physicians in the rate of medically inappropriate orders (19% vs 22%) (two-proportion test, p=0.850) compared with that before the intervention (56% vs 31%) (two-proportion test, p<0.01). Overall rates of CT C-spine scans ordered decreased from 69.3 to 62.6/week (t-test, p=0.019).ConclusionA validated clinical decision-making tool implemented into the medical record can improve quality of care. This study lays a foundation for other imaging studies with validated support tools with similar potential improvements.

Measuring appropriateness of diagnostic imaging: a scoping review

“…Five included studies (10%) were interventional studies [83,87,97,106,107]. The analyzed interventions included guideline implementations [83,87,107], radiological consultations [97] for residents and clinical decision support systems [106].…”

“…Five included studies (10%) were interventional studies [83,87,97,106,107]. The analyzed interventions included guideline implementations [83,87,107], radiological consultations [97] for residents and clinical decision support systems [106]. Two guideline implementations [83,107] and clinical decision support [106] showed significantly improved appropriateness results.…”

“…The analyzed interventions included guideline implementations [83,87,107], radiological consultations [97] for residents and clinical decision support systems [106]. Two guideline implementations [83,107] and clinical decision support [106] showed significantly improved appropriateness results. Radiological consultation did not reveal significant changes [97].…”

“…Fourteen studies rated the appropriateness of spinal imaging [21, 63, 70, 80, 83-85, 87, 93, 98-100, 105, 106] including 1941 MRIs (adults: 1928, pediatric: 13) [21,63,70,80,105], 1679 CTs [21,63,83,93,[98][99][100]106], and 851 radiographs [83][84][85]87]. Spinal MRI showed an overall appropriateness of 63% (n = 1221/1928) in six studies using ACR AC [80], EU guidelines [70] or national guidelines [21,63,80,105].…”

Diagnostic accuracy of deep learning for evaluation of C-spine injury from lateral neck radiographs

“…Lateral neck radiographs have been reported as having a high false-negative rate and limited use in screening protocols [ 12 , 17 , 18 ]. However, other reports have found high negative rates of cervical CT scans in trauma settings, indicating the possibility that such scans were excessive, resulting higher-than-necessary costs [ 10 , 19 , 20 , 21 ].…”