Directions for Future Research: Adherence to the Canadian Computed Tomography Head Rules
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Transcript of Directions for Future Research: Adherence to the Canadian Computed Tomography Head Rules
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Directions for Future Research: Adherence to the Canadian Computed Tomography Head
Rules
E 4: Have a Complex Decision? Choose Your Tool
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Disclosure Slide
• UBC medical student
• No conflicts
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Who cares about CT’s
Canadians endure some of the longest ER wait times in the developed world.
Unnecessary scans reduce access to finite resource
Cost per CT ~$300
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The Numbers
» Kelowna General Hospital sees +70,000 patients per year
» 2500 CT’s were ordered by the ED in 2015
» A quality review of 175 CT’s found that 25% did NOT FOLLOW CCTHR
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The Study
Why low adherence rates?
What can be done to improve them?
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What we have done
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KGH ED: CANADIAN CT HEAD RULES CHECKLIST
Yes/No Criteria Description
High-Risk (for Neurosurgical Intervention)
Glascow Coma Scale <15 @ 2hr post injury
Suspected open or depressed skull
Any sign of basilar skull fracture , indicate which one:
- Hemotympanum
- Racoon Eyes
- Battle’s Sign
- CSF otorrhea-/rhinorrhea
Equal to or over 2 episodes of vomiting
Age > or equal to 65 years
MEDIUM-RISK (for Brain Injury on CT)
Retrograde Amnesia to the event > 30 min
Dangerous Mechanism of injury, indicate which one:
- Fall from over 3ft or +5 stairs
- Occupant ejected from motor vehicle
- Pedestrian struck by motor vehicle
Ordered CT for this patient
Did not order CT for this patient
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Low physician uptake to utilize checklist.
Challenges!
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Positive Change
Increased Awareness
Open dialogue
Collaborative approach
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Lesson Learned
• One perspective is not Universal
• Buy in is vital to change
• The small things can make
the difference
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Future Directions
» New study examines appropriateness of current age criteria of CCTHR
» Are patients 60-79 at a greater risk?
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Questions?
How would you increase uptake?
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Contact Information
Dr. Michael Ertel, CHIRPP PI, KGH Chief of Staff
Hannah Duyvewaardt, UBC Medical Student
Parm Brar, UBC Medical Student