Brain imaging may be overused in emergency departments for cases of mild traumatic brain injury

The Centers for Disease Control and Prevention estimate that the incidence of traumatic brain injury (TBI) has increased by 60% between 2001 and 2010. Every year in the United States, about five million people visit an emergency department (ED) seeking treatment for TBI, and about half of those people receive an official TBI diagnosis.

At the ED, clinicians physically examine patients, gather data about patients’ medical history, and typically perform computed tomography (CT) scans on patients to obtain brain images, which they use to make an official diagnosis. Recently, some have raised concerns about the time and cost associated with head CT scans. Although brain images are a useful diagnostic tool, head CT scans can significantly increase patient wait times and may not be less valuable for patients with mild TBI.

A group of American researchers collaborated on a study of the timing of a typical workup for patients who visit the ED with a suspected TBI. They collected data from hospital records to inform a potential “care map” for TBI patients, and they estimated that the average length of ED stay for TBI patients is about 6.6 hours. CT scan procedures accounted for about half of this time.

As a result, the researchers suggest limiting the use of head CT scans as part of the patient workup process to only the most serious TBI cases. Because ED visits for mild TBI are increasingly common, EDs may opt to use faster, more cost-effective methods for diagnosing TBI in milder concussion cases, reserving head CT scans for the most serious injury cases. Researchers predict that this would decrease patient wait times while allowing EDs to run more smoothly and efficiently.

Michelson EA, Huff JS, Loparo M, et al. Emergency department time course for mild traumatic brain injury workup. Western Journal of Emergency Medicine. (July 2018).

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