Abstract
Introduction:
Falls are a common occurrence in both inpatient and emergency settings with CT head imaging being the gold standard for assessing potential intracranial injuries. However, it was noted that CT scans are often inappropriately requested leading to unnecessary radiation exposure and increased healthcare costs.
The aim of the audit was to evaluate adherence to NICE Head Injury Guidelines on CT head[i] scanning after falls in a district hospital.
Methods:
In the first PDSA cycle, 50 adult patients who attended the ED with a fall were randomly selected. Data was collected retrospectively from radiology records and patient notes including age, anticoagulation use, details of the fall and whether a CT head scan was requested. The data was analysed using Microsoft Excel to determine the appropriateness of imaging decisions.
Teaching was delivered on platforms such as weekly grand-rounds, and a trust-wide e-mail was sent out to doctors to emphasize the importance of adherence to NICE guidelines.
A further PDSA cycle was conducted in April 2025 involving another set of 50 random patients in a similar manner.
Results:
Results of the first cycle revealed that 45 out of 50 patients had CT head scans requested, out of which only 20 met NICE criteria (44%) whereas 56% did not.
Following intervention, the second cycle showed that 47 out of 50 patients had CT scans requested. 30 requests (64%) met NICE criteria whereas the remaining 17 (35%) did not.
Overall, the percentage of inappropriate requests decreased by 20%
Conclusion:
The audit demonstrates overall potential overuse of CT head scans, however interventions such as reinforcing education on the use of guidelines and decision support tools such as proformas and electronic prompts may potentially reduce unnecessary imaging.
References:
[i]Recommendations | Head injury: assessment and early management | Guidance | NICE
https://www.nice.org.uk/guidance/ng232/chapter/Recommendations#investigating-clinically-important-traumatic-brain-injuries
Comments
Question
Hello. Thank you for the poster on your quality improvement work. Despite considerable improvement, you found that 36% still had a CT head inappropriately; what plans are in place to reduce this number further?
Hi. Thanks for taking the…
Hi. Thanks for taking the time out to review our poster. We are now aiming to add an electronic prompt when requesting a CT head that would say ‘if the CT request after a head injury, have NICE guidelines been reviewed’. Hoping this would act as a reminder for junior doctors to review guidance prior to requesting CT head scans.
Thank you for your poster, I…
Thank you for your poster, I wonder what your opinion is on whether a similar approach could be taken in the community to reduce unnecessary ambulance callouts for community based falls?
That is a great idea however…
That is a great idea however in order to reduce ambulance call-outs but still make sure all falls are appropriately assessed for possible escalation, implement alternative response pathways eg falls response teams or non-emergency helplines who can do the inital assessments. This will definitely reduce unncessary ambulance call outs and ED attendences.
Does your Trust have any…
Does your Trust have any local guidelines - based on NICE guidance - to help with decision making around requesting CT Head scans at presentation in the ED? Do you plan to have a local guideline developed given the findings of your audit?