Audit of Computed Tomography (Brain) Referrals from the Accident and Emergency Department in a Tertiary Care Hospital
Introduction: Non-contrast Computerised 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...
Main Authors: | , , |
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Format: | Article |
Language: | English |
Published: |
JCDR Research and Publications Private Limited
2021-06-01
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Series: | Journal of Clinical and Diagnostic Research |
Subjects: | |
Online Access: | https://www.jcdr.net/articles/PDF/14970/46166_CE[Ra1]_F[SK]%20PF1%20AKA_[IK]_PFA(AKA_KM)_PN(KM).pdf |
Summary: | Introduction: Non-contrast Computerised 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 non-contrast
computed tomography 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 group’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 other
miscellaneous findings) 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) criteria was
then tabulated. Non-trauma reports were also further classified
in to 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. The 144 (58.5%) out of trauma cases
and 328 (27.2%) out of non trauma cases were with major
findings. 788 (80.4%) of trauma cases and 965 (80.1%) out
of non trauma 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. |
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ISSN: | 2249-782X 0973-709X |