Audit of Computed Tomography (Brain) Referrals from the Accident and Emergency Department in a Tertiary Care Hospital
TC01-TC04
Correspondence
Yashasvi Shukla,
901 D1, Akash Enclave, Vrindavan Yojna, Lucknow, Uttar Pradesh, India.
E-mail: shukla_yashasvi@yahoo.in
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 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 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.