MedicalResearch.com Interview with:
Dr. Jennifer Marin MD MSc
Director of Emergency Ultrasound
Division of Pediatric Emergency Medicine
Assistant Professor of Pediatrics and Emergency Medicine
University of Pittsburgh School of Medicine
Medical Research: What is the background for this study? What are the main findings?
Dr. Marin: Overuse of diagnostic imaging in the emergency department has become a focus of concern from policy makers, patients, and physicians. There are evidence-based clinical decision rules and policy recommendations published in order to optimize the use of such imaging. However, physicians don’t necessarily use these tools in their decision-making. Head computed tomography (CT) imaging for patients with minor head trauma is a common CT performed in the emergency setting. Our study sought to evaluate how often physicians adhered to the American College of Emergency Physicians (ACEP) Clinical Policy on Neuroimaging. The policy outlines which patients warrant a CT in the setting of minor head trauma based on certain factors, such as age, mechanism of injury, and signs and symptoms of head trauma. What we found is that when the policy recommends that a head CT be performed, it is obtained more than 90% of the time. However, when a head CT is not recommended, it is actually obtained in nearly half of those patients. We hope this will draw attention to decision rules and clinical policies, such as that from ACEP, and remind physicians that using these tools can assist in appropriate imaging practices.
MedicalResearch.com: What further research do you recommend as a result of this work?
Dr. Marin: There are certainly many areas on which to expand our research. The next step would be to evaluate reasons why physicians don’t adhere to these guidelines, specifically, when a CT is not recommended.
Adherence to a clinical decision policy for head computed tomography in adult mild traumatic brain injury
Marin, Jennifer R. et al
The American Journal of Emergency Medicine
Published Online: November 19, 2014