Audit of Computed Tomography (Brain) Referrals from the Accident and Emergency Department in a Tertiary Care HospitalCorrespondence Address :
901 D1, Akash Enclave, Vrindavan Yojna, Lucknow, Uttar Pradesh, India.
Introduction: Non-Contrast Computed Tomography (NCCT) brain is a common referral made from the Accident and Emergency (A&E) Department both for traumatic and non traumatic causes.
Aim: To evaluate the veracity of the referrals made by the Accident and Emergency Department clinicians for NCCT Head.
Materials and Methods: This was the Retrospective evaluation of diagnostic yield of head Computed Tomography (CT) referrals made from A&E Department of a tertiary care hospital located in northern-central India over three year period between January 2015 to December 2017. CT reports were first grouped into two major groupâ€™s trauma and non trauma referrals with further subdivision into positive and negative scan on the basis of presence of abnormality. Subsequently, the positive trauma reports were classified into major findings (three subgroups extra-axial haemorrhage, brain contusions and depressed skull fractures) and minor findings like undisplaced fractures of the skull or facial bones with or without subgaleal haematoma. Distribution of trauma cases as per National Institute for Health and Care Excellence (NICE) guidelines was then tabulated. Non trauma reports were also further classified into the two major clinically important findings of haemorrhage and infarct as well as non-specific minor findings.
Results: Of the total data of 2185 head CT (980 trauma cases and 1205 in non trauma cases) referrals done by A&E Department during the study period. Out of total, 144 (58.5%) of trauma cases and 328 (27.2%) of non trauma cases were with major findings. Trauma 788 cases and non trauma 965 cases were referred by Medical Officer (MO)/ Resident as revealed from the audit. Positivity percentages for traumatic and non traumatic causes were 25.1% and 27.2%, respectively.
Conclusion: Due to non adherence to existing guidelines or due to poor clinical knowledge, there is poor diagnostic yield of CT referrals made from A&E Department. Thus clinical audit is essential at Department of Radiodiagnosis to streamline the referring protocols and improves the overall efficiency of the healthcare system.
Clinical audit, Glasgow coma scale, Head Injury, Non-contrast computed tomography, National institute for health and care excellence guidelines
Date of Submission: Aug 01, 2020
Date of Peer Review: Oct 29, 2020
Date of Acceptance: Mar 30, 2021
Date of Publishing: Jun 01, 2021
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? NA
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Aug 08, 2020
• Manual Googling: Mar 25, 2021
• iThenticate Software: Apr 19, 2021 (3%)
ETYMOLOGY: Author Origin
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- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
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- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)