Stricter adherence to preliminary screening method could reduce unnecessary CT scans
A Henry Ford Hospital study has found that better use of commonly accepted diagnostic guidelines for detecting cervical spine injuries could reduce unnecessary CT scans and spare patients from radiation exposure.
The multi-phase study showed that a significant number of CT scans could have been avoided if physicians adhered to the National Emergency X-Radiology Study (NEXUS) criteria, which aid Emergency Department physicians with determining whether C-spine injuries exist. Key findings:
- In Phase 1, 24 percent of 1,524 CT scans were potentially unnecessarily.
- In Phase 2, 16 percent of 502 CT scans were potentially unnecessarily.
"While imaging testing is an important aspect of patient care, we have to make sure that these tests are ordered appropriately," says Brent Griffith, M.D., chief resident of Radiology at Henry Ford and the study's lead author. "With an emphasis nationally on decreasing radiation exposure and improving the use of health care resources, it's important that both radiologists and clinicians address the appropriate use of all imaging tools."
An estimated 1 million people are treated for a potential C-spine injury from blunt trauma in the Emergency Department every year, with falls and motor vehicle accidents being the most common causes. Because a delay or failure to diagnose C-spine injuries can lead to permanent paralysis, physicians often have a low threshold for ordering imaging tests.
In 2000, the NEXUS criteria established low-risk guidelines to identify patients with a low probability of cervical spine injury that didn't need an imaging test. To be cleared of a C-spine injury, a patient must have the following:
- No tenderness at the middle of the neckline.
- No evidence of intoxication.
- Normal level of alertness.
- No evidence of focal neurologic deficit (numbness or weakness).
- No other painful distracting injury (e.g. long bone fracture).
Despite these preliminary screening tools, prior research has shown that patients continue to receive imaging tests without meeting the criteria. Henry Ford researchers sought to evaluate whether strict adherence to the NEXUS criteria could decrease the number of imaging tests ordered.
In the study's Phase 1, researchers evaluated 1,524 imaging tests conducted from January-December 2008 that were negative for an acute c-spine injury. Of those tests, 24 percent showed no documentation of the NEXUS criteria being applied.
In the study's Phase 2, researchers enrolled patients who presented to the Emergency Department between March and November 2011 for whom a CT scan was ordered for detecting a c-spine injury. For each CT scan ordered, the requesting clinician was instructed to complete a survey about the type of injury, reason for ordering the scan and clinical suspicion of injury. The CT scans were evaluated by a board-certified radiologist blinded to the survey data to determine the presence or absence of C-spine injury.
Researchers theorize the heightened awareness of the survey was a factor in the reduction of CT scans to 16 percent in Phase 2 from 24 percent in Phase 1.
For the study's Phase 3, researchers established an education program to instruct physicians about the NEXUS criteria for ordering imaging tests for c-spine injuries. Preliminary findings demonstrate a trend showing improved but not statistically significant utilization of imaging tests using the NEXUS criteria.
Provided by Henry Ford Health System
- Canadian C-spine rule more accurate in diagnosing important cervical spine injuries than other rules Oct 09, 2012 | not rated yet | 0
- Simple assault and ground level fall do not require cervical spine CT May 03, 2012 | not rated yet | 0
- CT technique eliminates the need for X-rays in trauma patients with possible spinal fractures May 06, 2010 | not rated yet | 0
- Use of advanced radiology for injury-related emergency department visits increases significantly Oct 05, 2010 | not rated yet | 0
- Top down approach helps academic medical center reduce unnecessary emergency department X-rays Jul 01, 2010 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Why is zone 1 in liver more prone to ischemic injury?
19 hours ago Hi, Is it because around central vein, there is only deoxygenated blood from the vein where as in the periphery there is hepatic artery. Also why...
How can there be villous adenoma in colon, if there are no villi there
May 22, 2013 As title suggest. Thanks :smile:
How can there be a term called "intestinal metaplasia" of stomach
May 21, 2013 Hello everyone, Ok Stomach's normal epithelium is simple columnar, now in intestinal type of adenocarcinoma of stomach it undergoes "intestinal...
Pressure-volume curve: Elastic Recoil Pressure don't make sense
May 18, 2013 From pressure-volume curve of the lung and chest wall (attached photo), I don't understand why would the elastic recoil pressure of the lung is...
If you became brain-dead, would you want them to pull the plug?
May 17, 2013 I'd want the rest of me to stay alive. Sure it's a lousy way to live but it beats being all-the-way dead. Maybe if I make it 20 years they'll...
MRI bill question
May 15, 2013 Dear PFers, The hospital gave us a $12k bill for one MRI (head with contrast). The people I talked to at the hospital tell me that they do not...
- More from Physics Forums - Medical Sciences
More news stories
Breast cancer characterized as "triple negative" carries a poor prognosis, with limited treatment options. In some cases, chemotherapy doesn't kill the cancer cells the way it's supposed to. New research from Western University ...
Cancer 5 hours ago | 5 / 5 (2) | 0
Mayo Clinic researchers have used next generation genomic analysis to determine that some of the more aggressive prostate cancer tumors have similar genetic origins, which may help in predicting cancer progression. The findings ...
Cancer 5 hours ago | not rated yet | 0
Even while being dragged to its destruction inside a cell, a cancer-promoting growth factor receptor fires away, sending signals that thwart the development of tumor-suppressing microRNAs (miRNAs) before it's dissolved, researchers ...
Cancer 6 hours ago | not rated yet | 0 |
Treating pediatric leukemia patients with a liposomal formulation of anthracycline-based chemotherapy at a more intense-than-standard dose during initial treatment may result in high survival rates without causing any added ...
Cancer 10 hours ago | not rated yet | 0
Scientists have uncovered a survival mechanism that occurs in breast cells that have just turned premalignant-cells on the cusp between normalcy and cancers-which may lead to new methods of stopping tumors.
Cancer 11 hours ago | not rated yet | 0 |
(Medical Xpress)—Regulating the distribution of power in neurons is done by a system that makes the national electric grid look simple by comparison. Each neuron has several thousand mitochondria confined ...
5 hours ago | 4.8 / 5 (5) | 0 |
Teams of highly respected Alzheimer's researchers failed to replicate what appeared to be breakthrough results for the treatment of this brain disease when they were published last year in the journal Science.
9 hours ago | 5 / 5 (1) | 2 |
A brief visual task can predict IQ, according to a new study. This surprisingly simple exercise measures the brain's unconscious ability to filter out visual movement. The study shows that individuals whose ...
11 hours ago | 4.9 / 5 (7) | 0 |
Scientists at the National Institutes of Health report they have discovered in mouse studies that a small molecule released in the spinal cord triggers a process that is later experienced in the brain as ...
9 hours ago | 5 / 5 (2) | 0 |
Little is known about why asthma develops, how it constricts the airway or why response to treatments varies between patients. Now, a team of researchers at Weill Cornell Medical College, Columbia University Medical Center ...
9 hours ago | not rated yet | 0 |
Ethnic background plays a surprisingly large role in how diabetes develops on a cellular level, according to two new studies led by researchers at the Stanford University School of Medicine.
7 hours ago | not rated yet | 0 |