Diagnostic Yield of CT Brain Studies in the Emergency Service of a Tertiary Care Center: A Retrospective Audit of 130 Patients

Introduction: Cork University Hospital (CUH) is a large, tertiary referral trauma center. There were approximately 48,P020 attendances at the emergency department (ED) in 2011. The ED is supported by in-house neurology, neurosurgery, and neuroradiology services. Computed tomographic (CT) brain studies form an essential component of patient management in the ED. This audit was aimed at investigating the diagnostic yield of such scans.

Methods: Using the computer-based picture archiving and communication system, CT brain scans performed in a 1-week period were selected. Inclusion and exclusion criteria were applied. Quantitative and qualitative analysis of the scan requests was performed. These data were compared with the official radiology report accompanying each scan.

Results: Over the audit period 172 head CT scans were performed. Of these, 130 were eligible for inclusion in the audit. Stroke (n = 35, 27%), traumatic brain injury (n = 31, 24%), headache (n = 17, 13%), subarachnoid hemorrhage (n = 11, 8%), seizure (n = 10, 8%) and “collapse query cause” (n = 10, 8%) were the clinical scenarios that accounted for most CT brain requests. The diagnostic yield for all scans was 15%.

Conclusions: Clinically significant pathology was found in 15% of CT scan requests in CUH. Based on the analysis of physicians’ requests, a significant number of scans do not meet internationally agreed criteria for CT imaging. It may be possible to safely reduce the number of CT brain scans performed in CUH. We can potentially avoid unnecessary investigations for patients and use the available resources in a structured and efficient manner. We believe that our results have implications for undergraduate and postgraduate medical training in our health service.