Head CT scan in emergency room: Is it still abused? Quantification and causes analysis of overprescription in an Italian Emergency Department

Ferorelli, Davide; Donno, Francesca; Giorgio, Gianni De; Mele, Federica; Favia, Matteo; Riefoli, Flavia; Andresciani, Stefano; Melodia, Rosa; Zotti, Fiorenza; Dell’Erba, Alessandro

doi:10.1007/s11547-020-01143-9

Cited by 12 publications

(8 citation statements)

References 22 publications

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“…The results are presented in Fig. 2 [ 20 – 23 , 26 – 29 , 35 , 40 – 42 , 54 , 64 , 68 , 69 , 122 , 123 , 125 , 127 – 130 , 140 , 141 , 143 , 145 – 147 , 157 – 159 , 172 – 174 , 176 , 177 , 179 , 182 , 190 , 210 , 211 , 213 , 215 , 216 , 229 , 242 , 252 , 277 , 284 , 353 – 387 ]. From these studies, imaging examinations with a high proportion of low-value examinations (more than 50% inappropriate use reported) was: Head CT (routine and repeat), routine trauma scan, MRI in musculoskeletal pain, dual-energy x-ray absorptiometry (DEXA) in low risk patients or low interval DEXA follow-ups, echocardiography, carotid imaging, chest X-ray, X-ray in acute rhinosinusitis, CTA in pulmonary embolism, early-stage breast cancer staging, acute pancreatitis, and special imaging for pre-op templar bone CT in cochlear implantation, and CT/MRI in long bone cartilaginous lesions.…”

Section: The Quantity In Use Of Low-value Examinationsmentioning

confidence: 99%

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

et al. 2022

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Background Inappropriate and wasteful use of health care resources is a common problem, constituting 10–34% of health services spending in the western world. Even though diagnostic imaging is vital for identifying correct diagnoses and administrating the right treatment, low-value imaging—in which the diagnostic test confers little to no clinical benefit—is common and contributes to inappropriate and wasteful use of health care resources. There is a lack of knowledge on the types and extent of low-value imaging. Accordingly, the objective of this study was to identify, characterize, and quantify the extent of low-value diagnostic imaging examinations for adults and children. Methods A scoping review of the published literature was performed. Medline-Ovid, Embase-Ovid, Scopus, and Cochrane Library were searched for studies published from 2010 to September 2020. The search strategy was built from medical subject headings (Mesh) for Diagnostic imaging/Radiology OR Health service misuse/Medical overuse OR Procedures and Techniques Utilization/Facilities and Services Utilization. Articles in English, German, Dutch, Swedish, Danish, or Norwegian were included. Results A total of 39,986 records were identified and, of these, 370 studies were included in the final synthesis. Eighty-four low-value imaging examinations were identified. Imaging of atraumatic pain, routine imaging in minor head injury, trauma, thrombosis, urolithiasis, after thoracic interventions, fracture follow-up and cancer staging/follow-up were the most frequently identified low-value imaging examinations. The proportion of low-value imaging varied between 2 and 100% inappropriate or unnecessary examinations. Conclusions A comprehensive list of identified low-value radiological examinations for both adults and children are presented. Future research should focus on reasons for low-value imaging utilization and interventions to reduce the use of low-value imaging internationally. Systematic review registration: PROSPERO: CRD42020208072.

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Section: The Quantity In Use Of Low-value Examinationsmentioning

confidence: 99%

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

et al. 2022

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“…The studies were published during 1972–2021. Among those, the 50 European studies included in this systematic review2 3 5–8 16–20 22–25 34–68 were published during 1995–2020 with a steep increase in publications during the recent years (table 1, figure 2).…”

Section: Resultsmentioning

confidence: 99%

How defensive medicine is defined in European medical literature: a systematic review

et al. 2022

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ObjectivesDefensive medicine has originally been defined as motivated by fear of malpractice litigation. However, the term is frequently used in Europe where most countries have a no-fault malpractice system. The objectives of this systematic review were to explore the definition of the term ‘defensive medicine’ in European original medical literature and to identify the motives stated therein.DesignSystematic review.Data sourcesPubMed, Embase and Cochrane, 3 February 2020, with an updated search on 6 March 2021.MethodsFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we reviewed all European original peer-reviewed studies fully or partially investigating ‘defensive medicine’.ResultsWe identified a total of 50 studies. First, we divided these into two categories: the first category consisting of studies defining defensive medicine by using a narrow definition and the second category comprising studies in which defensive medicine was defined using a broad definition. In 23 of the studies(46%), defensive medicine was defined narrowly as: health professionals’ deviation from sound medical practice motivated by a wish to reduce exposure to malpractice litigation. In 27 studies (54%), a broad definition was applied adding … or other self-protective motives. These self-protective motives, different from fear of malpractice litigation, were grouped into four categories: fear of patient dissatisfaction, fear of overlooking a severe diagnosis, fear of negative publicity and unconscious defensive medicine. Studies applying the narrow and broad definitions of defensive medicine did not differ regarding publication year, country, medical specialty, research quality or number of citations.ConclusionsIn European research, the narrow definition of defensive medicine as exclusively motivated by fear of litigation is often broadened to include other self-protective motives. In order to compare results pertaining to defensive medicine across countries, future studies are recommended to specify whether they are using the narrow or broad definition of defensive medicine.PROSPERO registration numberCRD42020167215.

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“…Debate continues about the risk-benefit ratio of systematic WBCT when no injuries are clinically suspected. In this cohort of patients, WBCT does not seem to change patient management and hence should not be performed routinely [ 16 ]. On the other hand, there is a progressive increase in technology utilisation due to its greater availability, and an increase in the number of emergency department admissions for trauma.…”

Section: Indicationsmentioning

confidence: 99%

Current Standards for and Clinical Impact of Emergency Radiology in Major Trauma

Iacobellis

Abu-Omar

Crivelli

et al. 2022

IJERPH

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In industrialized countries, high energy trauma represents the leading cause of death and disability among people under 35 years of age. The two leading causes of mortality are neurological injuries and bleeding. Clinical evaluation is often unreliable in determining if, when and where injuries should be treated. Traditionally, surgery was the mainstay for assessment of injuries but advances in imaging techniques, particularly in computed tomography (CT), have contributed in progressively changing the classic clinical paradigm for major traumas, better defining the indications for surgery. Actually, the vast majority of traumas are now treated nonoperatively with a significant reduction in morbidity and mortality compared to the past. In this sense, another crucial point is the advent of interventional radiology (IR) in the treatment of vascular injuries after blunt trauma. IR enables the most effective nonoperative treatment of all vascular injuries. Indications for IR depend on the CT evidence of vascular injuries and, therefore, a robust CT protocol and the radiologist’s expertise are crucial. Emergency and IR radiologists form an integral part of the trauma team and are crucial for tailored management of traumatic injuries.

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Head CT scan in emergency room: Is it still abused? Quantification and causes analysis of overprescription in an Italian Emergency Department

Cited by 12 publications

References 22 publications

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

How defensive medicine is defined in European medical literature: a systematic review

Current Standards for and Clinical Impact of Emergency Radiology in Major Trauma

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