An initiative to educate patients about CT scans for mild traumatic brain injury
Mild traumatic brain injury (mTBI), or concussion, is a leading cause of admissions to health care centers across the world. In most cases, clinicians can diagnose concussions using self-reported symptoms and questionnaires. However, many patients and their families expect or ask for more intensive brain imaging procedures, such as computerized tomography (CT), which are rarely recommended for minor head injuries. Given the financial cost and low-dose radiation risks associated with CT scans, clinicians are reluctant to order these tests unless deemed absolutely necessary.
Choosing Wisely Canada (CWC) is an international initiative designed to reduce unnecessary medical procedures by opening a dialogue between physicians and patients about CWC guidelines for emergency medicine, which recommend that physicians “do not order CT scans in adults and children who have suffered minor head injuries (unless positive for a validated head injury clinical decision rule).” Although this recommendation seems clear, evidence suggests that inadequate patient-provider communication in emergency departments lead patients to retain only 20 percent of verbal instructions from their physicians. Health care providers are eager to improve these communication efforts to ensure that patients are well-informed and able to participate in the clinical decision-making process.
A Canadian research team evaluated the use of a patient infographic on perception of the risks, benefits, and necessity of CT scans for concussion. The infographic presented participants with facts about the CWC rule, the risks of radiation exposure from head CT scans, and a set of self-advocacy questions for patients who are considering a head CT. After reviewing the infographic, 115 participants completed a survey about their perceptions of head CT scans. The researchers found that:
- Before reading the infographic, 38 percent of participants thought that a CT scan was always recommended following a head injury of any severity. After reading it, only 19 percent of participants reported this belief.
- After reading the infographic, 87 percent of participants reported a better understanding of when a CT scan is necessary, 93 percent reported increased knowledge of the risks associated with CT scans, and 76 percent said they understood that doctors can diagnose concussion without brain imaging procedures.
- Nearly 90 percent of participants who read the infographic said they were more likely to ask their doctor about the risks and benefits of CT scans.
Patient-provider communication can be difficult, particularly in a high-stress, fast-paced emergency department environment. Fortunately, infographics are a promising way to provide patients with concise information, to encourage a dialogue between patients and physicians, and to promote health literacy.
Dowling S, Hair H, Boudreau D, et al. A patient-focused information design intervention to support the minor traumatic brain injuries (mTBI) Choosing Wisely Canada recommendation. Cureus. (October 2019.)