Retrospective analysis of head computed tomography investigations ordered by emergency department: comparison of clinical pre-diagnosis and radiologic results

Yıl 2020, , 103 - 110, 31.08.2020

Mustafa Mahmut Barış Ali Cantürk Nuri Karabay

https://doi.org/10.5505/deutfd.2020.66934

Öz

INTRODUCTION: Medical imaging, especially computed tomography (CT) utilization in emergency departments has increased in recent years. This leads to increase in total radiation dose per patient. To prevent unnecessary CT investigations, first we need to understand the dynamics between pre-diagnosis and radiologic results. Head CT is the most ordered CT investigation in emergency departments. In this study, we aimed to evaluate the relation between pre-diagnosis and radiologic results of head CT investigations.
METHODS: Retrospective analyze of head CT radiologic final reports and patients’ clinical records between 5 June 2019 and 5 September 2019 in emergency department was performed. Patients’ clinical records were used the define the pre-diagnosis leading to order head CT in the emergency department admittance.
RESULTS: Totally 2249 head CT investigations of 2039 patients were performed in defined time period at emergency radiology department. “Trauma” was the most frequent pre-diagnosis with 37% for ordering head CT in emergency department. In this group, radiologic results of head CTs were as fallow; 69% normal, 14% fracture and 7% hemorrhage. In syncope, headache and vertigo pre-diagnosis groups radiologic final diagnosis was normal in up to 95%.
DISCUSSION AND CONCLUSION: In this study, the most of the head CT investigations ordered by emergency department found to be normal. The reason for this high rate of normal results might be related with the high power of head CT to exclude acute pathology and emergency department doctors need to rule out acute pathology quickly.

Anahtar Kelimeler

emergency room, multidetector computed tomography, head trauma

Acil servisten istenen beyin BT tetkiklerinin retrospektif analizi: klinik ön tanı ve sonuç karşılaştırması

Öz

GİRİŞ ve AMAÇ: Son yıllarda acil servislerde başta bilgisayarlı tomografi (BT) olmak üzere medikal görüntüleme yöntemlerinin kullanımı oldukça artmıştır. Ancak artan BT kullanımı hasta başına düşen total radyasyon dozunun da artmasına neden olmaktadır. Gereksiz radyolojik tetkiklerin kontrol altına alınması ise cihazların etkin kullanımı ve radyolojik tetkik istem-sonuç ilişkisinin anlaşılması ile mümkündür. Acil servislerde en sık elde olunan BT tetkiki ise beyin BT incelemesidir. Bu çalışma ile acil servisten istenen beyin BT tetkiklerinin ön tanı-radyolojik sonuç dağılımın araştırılması amaçlanmıştır.
YÖNTEM ve GEREÇLER: Üniversite hastanemizin acil servisine hizmet veren acil radyoloji departmanında 5 Haziran 2019 - 5 Eylül 2019 tarihleri arasındaki üç aylık süreçte elde olunan beyin BT incelemelerinin raporları ve ilgili hasta dosyaları, klinik ön tanı ve radyolojik sonuç açısından retrospektif olarak analiz edilmiştir.
BULGULAR: 5 Haziran 2019- 5 Eylül 2019 tarihleri arasında, acil radyoloji departmanında 2039 adet hastaya ait 2249 adet beyin BT tetkiki elde olunmuştur. En sik beyin BT istem sebebi travmadır (%37). Travma on tanisi ile gelen hastalarin %69’si normal, %14’ü fraktur ve %7’si kanama olarak raporlanmistir. SVO ön tanısı ile gelen hastaların ise %63’si normal, %28’i enfarkt, %5’i kitle olarak raporlanmıştır. Senkop, baş ağrısı ve baş dönmesi ön tanıları %95’lere varan normal radyolojik son tanı oranlarına sahiptir.
TARTIŞMA ve SONUÇ: Bu çalışma sonucunda; acil BT tetkikleri arasında en sık uygulanan beyin BT incelemesi büyük oranda normal bulunmuş olup bu modalitenin sıklıkla olası patolojiyi dışlamak amacıyla istendiği düşünülmüştür.

Anahtar Kelimeler

acil servis, multidedektör bilgisayarlı tomografi, kafa travması

Kaynakça

• Bellolio MF, Bellew SD, Sangaralingham LR, Campbell RL, Cabrera D, Jeffery MM et al. Access to primary care and computed tomography use in the emergency department. BMC Health Serv Res. 2018;18:154-64.
• Seidel J, Bissell MB, Vatturi S, Hartery A. Retrospective analysis of emergency computed tomography imaging utilization at an academic center: an analysis of clinical indications and outcomes. Can Assoc Radiol J. 2019;70,13-22.
• Ahn S, Kim WY, Lim KS, Ryoo SM, Sohn CH, Seo DW et al. Advanced radiology utilization in a tertiary care emergency department from 2001 to 2010. PLoS ONE. 2014;9(11):e112650.
• Berdahl CT, Vermeulen MJ, Larson DB, Schull MJ. Emergency department computed tomography utilization in the United States and Canada. Ann Emerg Med. 2013;62:486-94.
• Kocher KE , Meurer WJ, Fazel R, Scott PA, Krumholz HM, Nallamothu BK. National trends in use of computed tomography in the emergency department. Ann Emerg Med. 2011; 58:452-62.
• Sosna J, Slasky BS, Bar-zıv J. Computed tomography in the emergency department. Am J Emerg Med. 1997;15:244-47.
• Kirsch TD, Hsieh YH, Horana L, Holtzclaw SG, Silverman M, Chanmugam A. Computed tomography scan utilization in emergency departments: a multi-state analysis. J Emerg Med. 2011; 41(3):302-9.
• Sinclair DE, Kovacs G, Hillis M. Cranial CT scans – emergency department utilization. J Emerg Med. 1993;11(5):643-6.
• Stiell IG, Wells GA, Vandemheen K, Clement K, Lesiuk H, Laupacis A et al. The Canadian CT head rule for patients with minor head injury. The Lancet. 2001;357,1391-96.
• Haydel MJ, Preston CA, Mills TJ, Luber S, Blaudeau E, DeBleux PMC. Indications for computed tomography in patients with minor head injury. N Engl J Med. 2000;343:100-5.
• Gupta V, Khandelwal N, Prabhakar A, Kumar AS, Ahuja CK, Singh P. Prevalence of normal head CT and positive CT findings in a large cohort of patients with chronic headaches. Neuroradiol J. 2015;28:421-5.
• Valença MM, Patrízia L Valença AA, Menezes TL. Computed tomography scan of the head in patients with migraine or tension-type headache. Arq Neuropsiquiatr. 2002;60(3-A):542-7.
• Holle D, Obermann M. The role of neuroimaging in the diagnosis of headache disorders. Ther Adv Neurol Disord. 2013;6:369–74.
• Cortelli P, Cevoli S, Nonino F, Baronciani D, Magrini N, Re G, et al. Evidence-based diagnosis of nontraumatic headache in the emergency department: a consensus statement on four Clinical scenarios. Headache. 2004;44:587-95.