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CT Scans Are Overused for Evaluating Mild Traumatic Brain Injury

Computerized tomography (CT) scans are a common and valuable tool for imaging the inside of a person’s body, enabling clinicians to non-invasively visualize injuries, disease, or other abnormalities. During a CT scan, an x-ray tube rotates around the patient’s body, generating 2D cross-sectional images of the area of interest. Clinicians often use this imaging technique to visualize brain damage in people who have sustained traumatic brain injury (TBI). The head CT is particularly useful for rapid, non-invasive diagnosis of brain damage and can provide information to enable clinicians to develop individualized treatment plans.

However, the CT scan is not without risk: because the technique uses x-rays, patients are exposed to small doses of radiation that may lead to cancer in an estimated 1 in 10,000 cases. To minimize the inherent risks of x-ray exposure, many clinicians try to limit the CT procedure to patients with moderate to severe TBI, whose injuries may be so life-threatening that the immediate benefits of CT scanning outweigh the potential risks related to radiation exposure.

A recent study highlighted an urgent need to reduce the number of unnecessary scans performed on low-risk patients with mild TBI. In this study, a research team evaluated 170 adult patients who received CT scans for a minor head injury. They used hospital records to determine if patients actually met criteria for receiving a head CT scan, based on four existing CT imaging guidelines from the National Institute for Health and Clinical Excellence, the New Orleans Criteria, the American College of Emergency Physicians, and the Canadian Computed Tomography Head Rules. The researchers determined that:

  • 26 of the 170 participants did not meet CT scan criteria on any of the four guidelines, indicating 15% CT scan overuse.
  • Younger patients (aged 20 to 30 years) were significantly more likely to receive an unnecessary CT scan than older patients, and the likelihood of unnecessary CT scans directly decreased as participants’ age increased.
  • Only 1% of the participants required emergency surgery.

Head CT remains a critically important technique for evaluating TBI patients. However, nearly 1 in 5 patients with mild TBI who receive head CT fail to meet criteria for the procedure, and only a very small percentage actually have brain injury that may require emergency surgery. Consequently, head CT is entirely unwarranted in most TBI patients, and overuse of the procedure risks the patient’s health and unnecessarily burdens the health care system. Health policy makers should aim to develop a standardized guideline for requesting head CT scans to reduce the number of people who receive unnecessary radiation exposure after mild TBI.

Shobeirian F, Ghomi Z, Soleimani R, et al. Overuse of brain CT scan for evaluating mild head trauma in adults. Emergency Radiology. (August 2020).

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