directions for future research: adherence to the canadian computed tomography head rules
TRANSCRIPT
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
Hannah Duyvewaardt, UBC Medical Student
Parm Brar, UBC Medical Student