directions for future research: adherence to the canadian computed tomography head rules

Directions for Future Research: Adherence to the Canadian Computed Tomography Head

Rules

E 4: Have a Complex Decision? Choose Your Tool

Disclosure Slide

• UBC medical student

• No conflicts

Who cares about CT’s

Canadians endure some of the longest ER wait times in the developed world.

Unnecessary scans reduce access to finite resource

Cost per CT ~$300

The Numbers

» Kelowna General Hospital sees +70,000 patients per year

» 2500 CT’s were ordered by the ED in 2015

» A quality review of 175 CT’s found that 25% did NOT FOLLOW CCTHR

The Study

Why low adherence rates?

What can be done to improve them?

What we have done

KGH ED: CANADIAN CT HEAD RULES CHECKLIST

Yes/No Criteria Description

High-Risk (for Neurosurgical Intervention)

Glascow Coma Scale <15 @ 2hr post injury

Suspected open or depressed skull

Any sign of basilar skull fracture , indicate which one:

- Hemotympanum

- Racoon Eyes

- Battle’s Sign

- CSF otorrhea-/rhinorrhea

Equal to or over 2 episodes of vomiting

Age > or equal to 65 years

MEDIUM-RISK (for Brain Injury on CT)

Retrograde Amnesia to the event > 30 min

Dangerous Mechanism of injury, indicate which one:

- Fall from over 3ft or +5 stairs

- Occupant ejected from motor vehicle

- Pedestrian struck by motor vehicle

Ordered CT for this patient

Did not order CT for this patient

Low physician uptake to utilize checklist.

Challenges!

Positive Change

Increased Awareness

Open dialogue

Collaborative approach

Lesson Learned

• One perspective is not Universal

• Buy in is vital to change

• The small things can make

the difference

Future Directions

» New study examines appropriateness of current age criteria of CCTHR

» Are patients 60-79 at a greater risk?

Questions?

How would you increase uptake?

Contact Information

Dr. Michael Ertel, CHIRPP PI, KGH Chief of Staff

Michael.Ertel@interiorhealth.ca

Hannah Duyvewaardt, UBC Medical Student

hannahduyv@gmail.com

Parm Brar, UBC Medical Student

P_Brar108@hotmail.com