Mohammad Saleem Shehzad Cheema, Salman Atiq.
Accident and emergency neuroimaging: is an optimization needed in ordered non-enhanced CT scans for brain imaging?.
Esculapio J Services Inst Med Sci Jan ;9(1):35-40.

Objective: To determine and characterize ordering of computed tomography scans for neuroimaging and to identify the frequency of negative non-enhanced computed tomography (NECT) in a prospective series of patients presenting to medical, surgical and pediatric floors of Accident and Emergency Department, so as to manipulate ordering practice by the referring physicians. Material & Methods: This study was conducted in Department of Radiology, Services Institute of Medical Sciences/ Services Hospital, Lahore, between January and June 2010. The study consecutively included all the cases from Accident and Emergency Department with neurological symptoms and signs undergoing CT head referred from medical, surgical and pediatric floors. The patients' medical records were reviewed. The study population consisted of 2570 patients, including 1611 men and 959 women, who were 1-75 years old (mean 42 years). Results: Interpretation of NECT heads was done for positive as well as negative cases. Of 2570 cases, 1155 cases (44.9%) were positive. The overall percentage of negative CT scans was high for medical emergencies, with only 481 cases (29.2%) out of 1647 revealing positive findings. The percentage of negative CT scans referred from surgical emergency was not as high as for medical emergencies, but the major head trauma was only productive for extra-axial bleed/ hematoma revealing 403 cases (44.6%). Minor head trauma was more commonly scanned with most of the CT scans head remarkable only for skull vault non-depressed fractures. Pediatric referrals positive percentage was again low with only 6 (28.5%) out of 21 cases positive for any underlying pathology. Conclusions: Optimization in the neuroimaging should be encouraged for more thoughtful use of imaging modalities in Accidents and Emergency departments to ensure patients' benefit from continued imaging innovation. An urgent CT head scan is deemed appropriate if it leads to an immediate change in a patient's management. Unnecessary use of neuroimaging, in particular to CT scan, has long-term effects of accumulated diagnostic radiation. Appropriateness of the requests should be evaluated according to the various guidelines.

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