Appropriateness of Computed Tomography Scan in Mild Traumatic Head Injury Among Adult Patients in Mulago National Referral Hospital, Uganda: a Cross-sectional Hospital Based Study

Abstract

Background Computed Tomographic (CT) scanning of the head can detect acute intracranial injury and help to identify patients requiring neurosurgical intervention. The inappropriate utilization of CT scan strains meagre imaging resources especially in resource-constrained settings and risks the patients to unnecessary radiation. The Canadian CT head rule (CCHR) is a validated clinical tool used to predict mild head injury patients that will have a clinically significant intracranial injury on head CT scan. This reduces the number of requested CT scans while at the same time ensuring that those who would benefit from it are easily identified. However, this tool has not been previously applied in many low income settings where it would be very useful. Objective To determine the appropriateness of head CT scans performed among patients with mild traumatic head injury based on the Canadian CT head rule (CCHR). Methods This was a cross sectional study conducted at the emergency department of Mulago Hospital involving 259 adults clinically diagnosed with mild head injury with a head CT scan performed. They were assessed using the CCHR for a prediction of whether a head CT scan was appropriate or inappropriate. The proportion of appropriate head CT scans was obtained. The participants were followed up to assess their health status. Results The common abnormal CT scan findings were comminuted and depressed skull fractures. The proportion of appropriate head CT scans performed based on the CCHR was 70.7%. Most participants with positive CT scan findings were classified as appropriate when the CCHR was applied. 81.6% (n = 62) of the participants whose CT scans were classified as inappropriate had normal findings. There was a statistically significant association between categories of CCHR classification (appropriate vs inappropriate) and CT scan findings (normal vs neurologically insignificant). Conclusion About one-third of head CT scans performed in this study were inappropriate by applying the CCHR. Avoidance of CT scan in such patients is unlikely to miss any important injuries. Findings from the study can guide the adoption and adaptation of CCHR use in emergency departments.