Campaign cuts unnecessary trauma CT scans without missed injuries

A 23-month programme at two University of Cincinnati emergency departments reduced unnecessary head and cervical-spine CT scans for low-risk trauma patients, according to reporting published by EurekAlert!. A review found no missed injuries or other evidence of harm after the change was introduced.

The campaign prevented more than 3,500 scans at the University of Cincinnati Medical Center and West Chester Hospital. The reduction was associated with about $6.2 million in avoided patient healthcare costs, based on an estimated $1,750 per scan. It also saved 14,168 hours of patient waiting time, using an average of roughly four hours for each scan.

The hospitals further avoided 6,021.4 millisieverts of radiation exposure. The study authors compared that amount with approximately 2,000 years of typical background radiation for one person.

Using established rules more consistently

Emergency clinicians already have decision rules to help determine whether a person with a head or neck injury needs imaging. These guidelines are intended to identify patients at meaningful risk of serious injury while allowing clinicians to avoid scans when the likelihood of finding a dangerous problem is low.

The University of Cincinnati campaign focused on making those rules part of routine practice. Emergency medicine providers took part in continuing education sessions covering the guidelines and the research supporting them. The relevant criteria were also built into the electronic health record used to order tests, prompting clinicians to consider whether a scan was warranted before placing an order.

The project addressed patients as well as staff. Some people arriving after trauma expected to receive a CT even when their clinical assessment suggested it was unnecessary. The hospitals developed information sheets to explain why imaging might not be appropriate and to reassure patients that declining a scan could represent careful treatment rather than a lack of care.

David Thompson, an associate professor of clinical emergency medicine and the University of Cincinnati College of Medicine’s director of quality improvement and patient safety, said the decision rules can identify serious injuries without exposing low-risk patients to avoidable testing. He told EurekAlert! that the review found no missed injury after the guidelines were followed.

Which patients may need imaging?

Not all head or neck trauma carries the same level of risk. Some patients with concussions or other injuries may still be classified as low risk after an examination. Others show warning signs that make a CT scan more appropriate.

The indicators listed in the report include a fall from a height, being thrown from a vehicle, weakness or numbness in a limb, blood in the ear, vomiting and confusion. Clinicians use these and other findings, together with the circumstances of an injury and the patient’s examination, to decide whether imaging is necessary.

That distinction matters because CT can provide rapid and valuable information, but it also consumes time and exposes patients to ionising radiation. A scan may require patients to remain in an already crowded emergency department while equipment and staff are available. Avoiding tests that are unlikely to change treatment can therefore benefit both individual patients and the wider department.

The findings were reported in the Western Journal of Emergency Medicine by Thompson, Anita Goel and colleagues. Goel is an associate professor of clinical emergency medicine. The research team also included emergency medicine resident Jude Luke, medical student Rebecca Kubick, research professor Heidi Sucharew, Natalie Kreitzer, and staff from the UC Health Office of Performance Improvement.

A test in a busy trauma centre

The results are notable because the programme was carried out in a high-volume setting rather than a small or highly specialised service. UC Medical Center is the Greater Cincinnati region’s only academic medical centre and a Level I adult trauma centre. Its emergency department has 81 beds and is described as being almost continually full.

The rate of head and cervical-spine CT scanning fell at both participating hospitals by the end of the campaign. The outcome review did not identify an injury that had been missed because a scan was avoided. That result supports the use of structured clinical assessment in patients judged to be low risk, while leaving clinicians able to order imaging when warning signs are present.

For Thompson, the project illustrates how quality improvement can align patient preferences with clinical practice. Patients want effective treatment, but that does not necessarily mean receiving every available test. Applying evidence-based rules can help emergency teams provide imaging when it is useful and avoid it when it is not, even under the pressure of a crowded department.