To assess appropriateness of CT Head Scan requests in Patients attending the hospital with Falls
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
Great Poster and Topic
Thanks for sharing this poster. I appreciate the interest in investigating unnecessary CT Heads, where Emergency Departments are often full of these, which leads to unnecessary delays. I also did a similar Trauma related guidance on this in my local hospital. Its great seeing more interest in avoiding unnecessary CT scans.
However, I do wonder whether your team has elaborated on what is an "unnecessary" CT scan for a patient who had a fall. Was this determined solely by not following the NICE guidelines? Or were symptoms and clinical presentations taken into account as this could have a profound effect on your data.
Great poster and Topic! Thanks for sharing this.