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15 - The Great CT Debate

from Part III - Diagnosis and Management of Concussion

Published online by Cambridge University Press:  22 February 2019

By
Jeff Victoroff
Edited by
Jeff Victoroff  and
Erin D. Bigler
Jeff Victoroff
Affiliation:
University of Southern California, Torrance
Erin D. Bigler
Affiliation:
Brigham Young University, Utah
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Summary

When a person presents with an apparent acute concussive brain injury, whether at the Emergency Room or the primary care office, the treating physician must make just one life-or-death decision: obtain a CT scan? The recent announcement of a blood test that often detects intracranial hemorrhage has raised the hope of reducing the employment of CTs in some circumstances. But neither that innovation -- nor any review, no matter how systematic and comprehensive, nor any published algorithm -- can point to the right decision for every case. This chapter reviews both the evidence and the proliferation of published clinical guidelines, some of which comport with the evidence better than others. In the end, no clinical data reliably predict CT results. The physician is forced to make a decision under uncertainty. Either decision is risky business. The weight of evidence slightly favors the aphorism: when in doubt, scan.
Type
Chapter
Information
Concussion and Traumatic Encephalopathy
Causes, Diagnosis and Management
 , pp. 595 - 628
Publisher: Cambridge University Press
Print publication year: 2019

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References

Livingston, DH, Lavery, RF, Passannante, MR, Skurnick, JH, Baker, S, Fabian, TC, et al. Emergency department discharge of patients with a negative cranial computed tomography scan after minimal head injury. Ann Surg 2000; 232: 126–132.Google Scholar
Haydel, MJ, Preston, CA, Mills, TJ, Luber, S, Blaudeau, E, Deblieux, PM. Indications for computed tomography in patients with minor head injury. N Engl J Med 2000; 343: 100–105.Google Scholar
Malick, T, Milius, J, Fink, HJ. Dirty Harry: Screenplay. Hollywood, CA: Script City, 1970.Google Scholar
U.S. Food and Drug Administration. FDA authorizes marketing of first blood test to aid in the evaluation of concussion in adults. July 14, 2018. Available at: www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm596531.htm.Google Scholar
Kaplan, S, Belson, K. Concussions can be detected with new blood test approved by F.D.A. July 14, 2018. Available at: www.nytimes.com/2018/02/14/health/concussion-fda-bloodtest.html.Google Scholar
Stiell, IG, Wells, GA, Vandemheen, K, Clement, C, Lesiuk, H, Laupacis, A, et al. The Canadian CT head rule for patients with minor head injury. Lancet 2001; 357: 1391–1396.Google Scholar
Poon, WS, Rehman, SU, Poon, CY, Li, AK. Traumatic extradural hematoma of delayed onset is not a rarity. Neurosurgery 1992; 30: 681–686.Google Scholar
Dacey, RG, Jr., Alves, WM, Rimel, RW, Winn, HR, Jane, JA. Neurosurgical complications after apparently minor head injury. Assessment of risk in a series of 610 patients. J Neurosurg 1986; 65: 203–210.Google Scholar
Livingston, DH, Loder, PA, Koziol, J, Hunt, CD. The use of CT scanning to triage patients requiring admission following minimal head injury. J Trauma 1991; 31: 483–487; discussion 487–489.Google Scholar
Mohanty, SK, Thompson, W, Rakower, S. Are CT scans for head injury patients always necessary? J Trauma 1991; 31: 801–804; discussion 804–805.Google Scholar
Yuh, EL, Mukherjee, P, Lingsma, HF, Yue, JK, Ferguson, AR, Gordon, WA, et al. Magnetic resonance imaging improves 3-month outcome prediction in mild traumatic brain injury. Ann Neurol 2013; 73: 224–235.Google Scholar
Saboori, M, Ahmadi, J, Farajzadegan, Z. Indications for brain CT scan in patients with minor head injury. Clin Neurol Neurosurg 2007; 109: 399–405.CrossRefGoogle Scholar
Miller, EC, Derlet, RW, Kinser, D. Minor head trauma: Is computed tomography always necessary? Ann Emerg Med 1996; 27: 290–294.Google Scholar
Bazarian, JJ, McClung, J, Shah, MN, Cheng, YT, Flesher, W, Kraus, J. Mild traumatic brain injury in the United States, 1998–2000. Brain Inj 2005; 19: 85–91.CrossRefGoogle ScholarPubMed
Cassidy, JD, Carroll, LJ, Peloso, PM, Borg, J, Von Holst, H, Holm, L, et al. Incidence, risk factors and prevention of mild traumatic brain injury: Results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med 2004; 28–60.CrossRefGoogle ScholarPubMed
Faul, M, Xu, L, Wald, MM, Coronado, V. Traumatic brain injury in the United States: Emergency department vists, hospitalizations and deaths 2002–2006. Atlanta, GA: Centers for Disease Control and Prevention, 2010.Google Scholar
Feigin, VL, Theadom, A, Barker-Collo, S, Starkey, NJ, Mcpherson, K, Kahan, M, et al. Incidence of traumatic brain injury in New Zealand: A population-based study. Lancet Neurol 2013; 12: 53–64.Google Scholar
Langlois, JA, Kegler, SR, Butler, JA, Gotsch, KE, Johnson, RL, Reichard, AA, et al. Traumatic brain injury-related hospital discharges. Results from a 14-state surveillance system, 1997. MMWR Surveill Summ 2003; 52: 1–20.Google Scholar
Hanson, HR, Pomerantz, WJ, Gittelman, M. ED utilization trends in sports-related traumatic brain injury. Pediatrics 2013; 132: e859–e864.Google Scholar
New Zealand Guidelines roup. Traumatic brain injury: Diagnosis, acute management and rehabilitation. Wellington, NZ: New Zealand Guidelines Group, 2006.Google Scholar
Luoto, TM, Tenovuo, O, Kataja, A, Brander, A, Ohman, J, Iverson, GL. Who gets recruited in mild traumatic brain injury research? J Neurotrauma 2013; 30: 11–16.Google Scholar
Gentry, LR, Godersky, JC, Thompson, B, Dunn, VD. Prospective comparative study of intermediate-field MR and CT in the evaluation of closed head trauma. AJR Am J Roentgenol 1988; 150: 673–682.Google Scholar
Lee, H, Wintermark, M, Gean, AD, Ghajar, J, Manley, GT, Mukherjee, P. Focal lesions in acute mild traumatic brain injury and neurocognitive outcome: CT versus 3T MRI. J Neurotrauma 2008; 25: 1049–1056.Google Scholar
Mittl, RL, Grossman, RI, Hiehle, JF, Hurst, RW, Kauder, DR, Gennarelli, TA, et al. Prevalence of MR evidence of diffuse axonal injury in patients with mild head injury and normal head CT findings. AJNR Am J Neuroradiol 1994; 15: 1583–1589.Google ScholarPubMed
Toth, A. Magnetic resonance imaging application in the area of mild and acute traumatic brain injury: Implications for diagnostic markers? In: Kobeissy, FH, editor. Brain neurotrauma: Molecular, neuropsychological, and rehabilitation aspects. Boca Raton, FL: CRC Press/Taylor & Francis, 2015.Google Scholar
Hughes, DG, Jackson, A, Mason, DL, Berry, E, Hollis, S, Yates, DW. Abnormalities on magnetic resonance imaging seen acutely following mild traumatic brain injury: Correlation with neuropsychological tests and delayed recovery. Neuroradiology 2004; 46: 550–558.Google Scholar
Park, JH, Park, SW, Kang, SH, Nam, TK, Min, BK, Hwang, SN. Detection of traumatic cerebral microbleeds by susceptibility-weighted image of MRI. J Korean Neurosurg Soc 2009; 46: 365–369.Google Scholar
Stein, SC, Burnett, MG, Glick, HA. Indications for CT scanning in mild traumatic brain injury: A cost-effectiveness study. J Trauma 2006; 61: 558–566.Google Scholar
Graham, ID, Stiell, IG, Laupacis, A, O’connor, AM, Wells, GA. Emergency physicians’ attitudes toward and use of clinical decision rules for radiography. Acad Emerg Med 1998; 5: 134–140.CrossRefGoogle ScholarPubMed
Miller, EC, Holmes, JF, Derlet, RW. Utilizing clinical factors to reduce head CT scan ordering for minor head trauma patients. J Emerg Med 1997; 15: 453–457.Google Scholar
Servadei, F, Teasdale, G, Merry, G, Neurotraumatology Committee of the World Federation of Neurosurgical Societies. Defining acute mild head injury in adults: A proposal based on prognostic factors, diagnosis, and management. J Neurotrauma 2001; 18: 657–664.CrossRefGoogle ScholarPubMed
Mower, WR, Hoffman, JR, Herbert, M, Wolfson, AB, Pollack, CV, Jr., Zucker, MI, et al. Developing a clinical decision instrument to rule out intracranial injuries in patients with minor head trauma: Methodology of the NEXUS II investigation. Ann Emerg Med 2002; 40: 505–514.Google Scholar
Jagoda, AS, Bazarian, JJ, Bruns, JJ, Jr., Cantrill, SV, Gean, AD, Howard, PK, et al. Clinical policy: Neuroimaging and decision making in adult mild traumatic brain injury in the acute setting. Ann Emerg Med 2008; 52: 714–748.Google Scholar
SIGN. Early management of patients with a head injury: A national clinical guideline. Edinburgh, Scotland: Scottish Intercollegiate Guidelines Network, 2009.Google Scholar
ATLS Subcommittee, , American College of Surgeons’ Committee On Trauma, International ATLS Working Group. Advanced trauma life support (ATLS): the ninth edition. J Trauma Acute Care Surg 2013; 74: 1363–1366.Google Scholar
Ingebrigtsen, T, Romner, B, Kock-Jensen, C. Scandinavian guidelines for initial management of minimal, mild, and moderate head injuries. The Scandinavian Neurotrauma Committee. J Trauma 2000; 48: 760–766.Google Scholar
Sundstrom, T, Wester, K, Enger, M, Melhuus, K, Ingebrigtsen, T, Romner, B, et al. [Scandinavian guidelines for the acute management of adult patients with minimal, mild, or moderate head injuries.] Tidsskr Nor Laegeforen 2013; 133: e1–e6.Google Scholar
Hodgkinson, S, Pollit, V, Sharpin, C, Lecky, F, National Institute for Health and Care Excellence (NICE) Guideline Development Group. Early management of head injury: Summary of updated NICE guidance. BMJ 2014; 348: g104.Google Scholar
Smits, M, Dippel, DW, De Haan, GG, Dekker, HM, Vos, PE, Kool, DR, et al. External validation of the Canadian CT head rule and the New Orleans criteria for CT scanning in patients with minor head injury. JAMA 2005; 294: 1519–1525.Google Scholar
Stiell, IG, Clement, CM, Rowe, BH, Schull, MJ, Brison, R, Cass, D, et al. Comparison of the Canadian CT head rule and the New Orleans criteria in patients with minor head injury. JAMA 2005; 294: 1511–1518.Google Scholar
Jagoda, AS, Cantrill, SV, Wears, RL, Valadka, A, Gallagher, EJ, Gottesfeld, SH, et al. Clinical policy: Neuroimaging and decision making in adult mild traumatic brain injury in the acute setting. Ann Emerg Med 2002; 40: 231–249.Google Scholar
Barbosa, RR, Jawa, R, Watters, JM, Knight, JC, Kerwin, AJ, Winston, ES, et al. Evaluation and management of mild traumatic brain injury: An Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 2012; 73: S307–S314.Google Scholar
Employment Department of Local Affairs. Traumatic brain injury: Medical treatment guidelines. State of Colorado: Division of Workers’ Compensation; 2012.Google Scholar
Giza, CC, Kutcher, JS, Ashwal, S, Barth, J, Getchius, TS, Gioia, GA, et al. Summary of evidence-based guideline update: Evaluation and management of concussion in sports: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 2013; 80: 2250–2257.Google Scholar
Management of Concussion/mTBI Working Group. VA/DoD clinical practice guideline for management of concussion/mild traumatic brain injury. J Rehabil Res Dev 2009; 46: CP1–CP68.Google Scholar
NSW Ministry of Health. Adult trauma clinical practice guideline: Initial management of closed head injury in adults, 2nd edition. North Sydney: NSW Ministry of Health, 2011.Google Scholar
McCrory, P, Meeuwisse, WH, Aubry, M, Cantu, B, Dvorak, J, Echemendia, RJ, et al. Consensus statement on concussion in sport: The 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med 2013; 47: 250–258.Google Scholar
Anonymous. Guidelines for concussion/mTBI & persistent symptoms: second edition. 2013. http://onf.org/documents/guidelines-for-concussion-mtbi-persistent-symptoms-second-edition.Google Scholar
Unden, J, Ingebrigtsen, T, Romner, B, Scandinavian Neurotrauma Committee. Scandinavian guidelines for initial management of minimal, mild and moderate head injuries in adults: An evidence and consensus-based update. BMC Med 2013; 11: 50.Google Scholar
Dunning, J, Daly, JP, Lomas, JP, Lecky, F, Batchelor, J, Mackway-Jones, K, et al. Derivation of the children’s head injury algorithm for the prediction of important clinical events decision rule for head injury in children. Arch Dis Child 2006; 91: 885–891.Google Scholar
Harty, E, Bellis, F. CHALICE head injury rule: An implementation study. Emerg Med J 2010; 27: 750–752.Google Scholar
National Institute for Health and Care Excellence. Head injury guideline. 2007. www.nice.org.uk/CG56 (accessed 20 Dec 2008).Google Scholar
American College of Cardiology Surgeons. ATLS student course manual: Advanced trauma life support, 9th edition. Chicago, IL: Advanced Trauma Life Support (ATLS), American College of Cardiology (ACS), 2012.Google Scholar
Ibanez, J, Arikan, F, Pedraza, S, Sanchez, E, Poca, MA, Rodriguez, D, et al. Reliability of clinical guidelines in the detection of patients at risk following mild head injury: Results of a prospective study. J Neurosurg 2004; 100: 825–834.Google Scholar
Papa, L, Stiell, IG, Clement, CM, Pawlowicz, A, Wolfram, A, Braga, C, et al. Performance of the Canadian CT head rule and the New Orleans criteria for predicting any traumatic intracranial injury on computed tomography in a United States level I trauma center. Acad Emerg Med 2012; 19: 2–10.Google Scholar
Lannsjo, M, Backheden, M, Johansson, U, Af Geijerstam, JL, Borg, J. Does head CT scan pathology predict outcome after mild traumatic brain injury? Eur J Neurol 2013; 20: 124–129.Google Scholar
Jacobs, B, Beems, T, Stulemeijer, M, Van Vugt, AB, Van Der Vliet, TM, Borm, GF, et al. Outcome prediction in mild traumatic brain injury: Age and clinical variables are stronger predictors than CT abnormalities. J Neurotrauma 2010; 27: 655–668.Google Scholar
Albers, CE, Von Allmen, M, Evangelopoulos, DS, Zisakis, AK, Zimmermann, H, Exadaktylos, AK. What is the incidence of intracranial bleeding in patients with mild traumatic brain injury? A retrospective study in 3088 Canadian CT head rule patients. Biomed Res Int 2013; 2013: 453978.Google Scholar
Fabbri, A, Servadei, F, Marchesini, G, Stein, SC, Vandelli, A. Observational approach to subjects with mild-to-moderate head injury and initial non-neurosurgical lesions. J Neurol Neurosurg Psychiatry 2008; 79: 1180–1185.Google Scholar
White, CL, Griffith, S, Caron, JL. Early progression of traumatic cerebral contusions: Characterization and risk factors. J Trauma 2009; 67: 508–514; discussion 514–515.Google Scholar
Holmes, MW, Goodacre, S, Stevenson, MD, Pandor, A, Pickering, A. The cost-effectiveness of diagnostic management strategies for adults with minor head injury. Injury 2012; 43: 1423–1431.Google Scholar
Reinus, WR, Wippold, FJ, 2nd, Erickson, KK. Practical selection criteria for noncontrast cranial computed tomography in patients with head trauma. Ann Emerg Med 1993; 22: 1148–1155.Google Scholar
Atzema, C, Mower, WR, Hoffman, JR, Holmes, JF, Killian, AJ, Oman, JA, et al. Defining “therapeutically inconsequential” head computed tomographic findings in patients with blunt head trauma. Ann Emerg Med 2004; 44: 47–56.Google Scholar
Borczuk, P. Predictors of intracranial injury in patients with mild head trauma. Ann Emerg Med 1995; 25: 731–736.Google Scholar
Bouida, W, Marghli, S, Souissi, S, Ksibi, H, Methammem, M, Haguiga, H, et al. Prediction value of the Canadian CT head rule and the New Orleans criteria for positive head CT scan and acute neurosurgical procedures in minor head trauma: A multicenter external validation study. Ann Emerg Med 2013; 61: 521–527.Google Scholar
Brown, AJ, Witham, MD, George, J. Development of a risk score to guide brain imaging in older patients admitted with falls and confusion. Br J Radiol 2011; 84: 756–757.Google Scholar
Clement, CM, Stiell, IG, Schull, MJ, Rowe, BH, Brison, R, Lee, JS, et al. Clinical features of head injury patients presenting with a Glasgow Coma Scale score of 15 and who require neurosurgical intervention. Ann Emerg Med 2006; 48: 245–251.Google Scholar
Culotta, VP, Sementilli, ME, Gerold, K, Watts, CC. Clinicopathological heterogeneity in the classification of mild head injury. Neurosurgery 1996; 38: 245–250.Google Scholar
Fabbri, A, Servadei, F, Marchesini, G, Dente, M, Iervese, T, Spada, M, et al. Clinical performance of NICE recommendations versus NCWFNS proposal in patients with mild head injury. J Neurotrauma 2005; 22: 1419–1427.Google Scholar
Feuerman, T, Wackym, PA, Gade, GF, Becker, DP. Value of skull radiography, head computed tomographic scanning, and admission for observation in cases of minor head injury. Neurosurgery 1988; 22: 449–453.Google Scholar
Gomez, PA, Lobato, RD, Ortega, JM, De La, Cruz J. Mild head injury: Differences in prognosis among patients with a Glasgow Coma Scale score of 13 to 15 and analysis of factors associated with abnormal CT findings. Br J Neurosurg 1996; 10: 453–460.Google Scholar
Harad, FT, Kerstein, MD. Inadequacy of bedside clinical indicators in identifying significant intracranial injury in trauma patients. J Trauma 1992; 32: 359–361; discussion 361–363.Google Scholar
Hsiang, JN, Yeung, T, Yu, AL, Poon, WS. High-risk mild head injury. J Neurosurg 1997; 87: 234–238.Google Scholar
Holmes, JF, Baier, ME, Derlet, RW. Failure of the Miller criteria to predict significant intracranial injury in patients with a Glasgow Coma Scale score of 14 after minor head trauma. Acad Emerg Med 1997; 4: 788–792.Google Scholar
Jeret, JS, Mandell, M, Anziska, B, Lipitz, M, Vilceus, AP, Ware, JA, et al. Clinical predictors of abnormality disclosed by computed tomography after mild head trauma. Neurosurgery 1993; 32: 9–15; discussion 15–16.Google Scholar
Kavalci, C, Aksel, G, Salt, O, Yilmaz, MS, Demir, A, Kavalci, G, et al. Comparison of the Canadian CT head rule and the New Orleans criteria in patients with minor head injury. World J Emerg Surg 2014; 9: 31.Google Scholar
Kisat, M, Zafar, SN, Latif, A, Villegas, CV, Efron, DT, Stevens, KA, et al. Predictors of positive head CT scan and neurosurgical procedures after minor head trauma. J Surg Res 2012; 173: 31–37.Google Scholar
Korley, FK, Morton, MJ, Hill, PM, Mundangepfupfu, T, Zhou, T, Mohareb, AM, et al. Agreement between routine emergency department care and clinical decision support recommended care in patients evaluated for mild traumatic brain injury. Acad Emerg Med 2013; 20: 463–469.Google Scholar
Ro, YS, Shin, SD, Holmes, JF, Song, KJ, Park, JO, Cho, JS, et al. Comparison of clinical performance of cranial computed tomography rules in patients with minor head injury: A multicenter prospective study. Acad Emerg Med 2011; 18: 597–604.Google Scholar
Rosengren, D, Rothwell, S, Brown, AF, Chu, K. The application of North American CT scan criteria to an Australian population with minor head injury. Emerg Med Australas 2004; 16: 195–200.Google Scholar
Saadat, S, Ghodsi, SM, Naieni, KH, Firouznia, K, Hosseini, M, Kadkhodaie, HR, et al. Prediction of intracranial computed tomography findings in patients with minor head injury by using logistic regression. J Neurosurg 2009; 111: 688–694.Google Scholar
Shackford, SR, Wald, SL, Ross, SE, Cogbill, TH, Hoyt, DB, Morris, JA, et al. The clinical utility of computed tomographic scanning and neurologic examination in the management of patients with minor head injuries. J Trauma 1992; 33: 385–394.Google Scholar
Sharif-Alhoseini, M, Khodadadi, H, Chardoli, M, Rahimi-Movaghar, V. Indications for brain computed tomography scan after minor head injury. J Emerg Trauma Shock 2011; 4: 472–476.Google Scholar
Smits, M, Dippel, DW, Steyerberg, EW, De Haan, GG, Dekker, HM, Vos, PE, et al. Predicting intracranial traumatic findings on computed tomography in patients with minor head injury: The CHIP prediction rule. Ann Intern Med 2007; 146: 397–405.Google Scholar
Stein, SC, Ross, SE. The value of computed tomographic scans in patients with low-risk head injuries. Neurosurgery 1990; 26: 638–640.Google Scholar
Stein, SC, Ross, SE. Moderate head injury: A guide to initial management. J Neurosurg 1992; 77: 562–564.Google Scholar
Stein, SC, Fabbri, A, Servadei, F, Glick, HA. A critical comparison of clinical decision instruments for computed tomographic scanning in mild closed traumatic brain injury in adolescents and adults. Ann Emerg Med 2009; 53: 180–188.Google Scholar
Turedi, S, Hasanbasoglu, A, Gunduz, A, Yandi, M. Clinical decision instruments for CT scan in minor head trauma. J Emerg Med 2008; 34: 253–259.Google Scholar
Uchino, Y, Okimura, Y, Tanaka, M, Saeki, N, Yamaura, A. Computed tomography and magnetic resonance imaging of mild head injury – Is it appropriate to classify patients with Glasgow Coma Scale score of 13 to 15 as “mild injury”? Acta Neurochir (Wien) 2001; 143: 1031–1037.Google Scholar
Vilke, GM, Chan, TC, Guss, DA. Use of a complete neurological examination to screen for significant intracranial abnormalities in minor head injury. Am J Emerg Med 2000; 18: 159–163.Google Scholar
Nagy, KK, Joseph, KT, Krosner, SM, Roberts, RR, Leslie, CL, Dufty, K, et al. The utility of head computed tomography after minimal head injury. J Trauma 1999; 46: 268–270.Google Scholar
Murshid, WR. Management of minor head injuries: Admission criteria, radiological evaluation and treatment of complications. Acta Neurochir (Wien) 1998; 140: 56–64.Google Scholar
Pandor, A, Goodacre, S, Harnan, S, Holmes, M, Pickering, A, Fitzgerald, P, et al. Diagnostic management strategies for adults and children with minor head injury: A systematic review and an economic evaluation. Health Technol Assess 2011; 15 (27):1–202.Google Scholar
Stiell, IG, Clement, CM, Grimshaw, JM, Brison, RJ, Rowe, BH, Lee, JS, et al. A prospective cluster-randomized trial to implement the Canadian CT head rule in emergency departments. CMAJ 2010; 182: 1527–1532.Google Scholar
Reynolds, TA. A Tunisian, a Canadian, and an American walk into a bar (sustaining mild head injury). Ann Emerg Med 2013; 61: 528–529.Google Scholar
Haydel, MJ. Clinical decision instruments for CT scanning in minor head injury. JAMA 2005; 294: 1551–1553.Google Scholar
Harnan, SE, Pickering, A, Pandor, A, Goodacre, SW. Clinical decision rules for adults with minor head injury: A systematic review. J Trauma 2011; 71: 245–251.Google Scholar
Eng, J, Chanmugam, A. Examining the role of cranial CT in the evaluation of patients with minor head injury: A systematic review. Neuroimaging Clin N Am 2003; 13: 273–282.Google Scholar
Munoz-Sanchez, MA, Murillo-Cabezas, F, Cayuela-Dominguez, A, Rincon-Ferrari, MD, Amaya-Villar, R, Leon-Carrion, J. Skull fracture, with or without clinical signs, in mTBI is an independent risk marker for neurosurgically relevant intracranial lesion: A cohort study. Brain Inj 2009; 23: 39–44.Google Scholar
Andronikou, S, Kilborn, T, Patel, M, Fieggen, AG. Skull fracture as a herald of intracranial abnormality in children with mild head injury: Is there a role for skull radiographs? Australas Radiol 2003; 47: 381–385.Google Scholar
Goh, KY, Ahuja, A, Walkden, SB, Poon, WS. Is routine computed tomographic (CT) scanning necessary in suspected basal skull fractures? Injury 1997; 28: 353–357.Google Scholar
Palchak, MJ, Holmes, JF, Vance, CW, Gelber, RE, Schauer, BA, Harrison, MJ, et al. A decision rule for identifying children at low risk for brain injuries after blunt head trauma. Ann Emerg Med 2003; 42: 492–506.Google Scholar
Heskestad, B, Baardsen, R, Helseth, E, Ingebrigtsen, T. Guideline compliance in management of minimal, mild, and moderate head injury: High frequency of noncompliance among individual physicians despite strong guideline support from clinical leaders. J Trauma Acute Care Surg 2008; 65: 1309–1313.Google Scholar
Rohacek, M, Albrecht, M, Kleim, B, Zimmermann, H, Exadaktylos, A. Reasons for ordering computed tomography scans of the head in patients with minor brain injury. Injury 2012; 43: 1415–1418.Google Scholar
Muller, K, Waterloo, K, Romner, B, Wester, K, Ingebrigtsen, T, Scandinavian Neurotrauma Committee. Mild head injuries: Impact of a national strategy for implementation of management guidelines. J Trauma 2003; 55: 1029–1034.Google Scholar
Eagles, D, Stiell, IG, Clement, CM, Brehaut, J, Taljaard, M, Kelly, AM, et al. International survey of emergency physicians’ awareness and use of the Canadian cervical-spine rule and the Canadian computed tomography head rule. Acad Emerg Med 2008; 15: 1256–1261.Google Scholar
Melnick, ER, Szlezak, CM, Bentley, SK, Dziura, JD, Kotlyar, S, Post, LA. CT overuse for mild traumatic brain injury. Jt Comm J Qual Patient Saf 2012; 38: 483–489.Google Scholar
Strand, IH, Solheim, O, Moen, KG, Vik, A. Evaluation of the Scandinavian guidelines for head injuries based on a consecutive series with computed tomography from a Norwegian university hospital. Scand J Trauma Resusc Emerg Med 2012; 20: 62.Google Scholar
Huang, X, Zhou, JC, Pan, KH, Zhao, HC. Awareness and use of the Canadian computed tomography head rule for mild head injury patients among Chinese emergency physicians. Pak J Med Sci 2013; 29: 951–956.Google Scholar
Jones, LA, Morley, EJ, Grant, WD, Wojcik, SM, Paolo, WF. Adherence to head computed tomography guidelines for mild traumatic brain injury. West J Emerg Med 2014; 15: 459–464.Google Scholar
Gupta, A, Ip, IK, Raja, AS, Andruchow, JE, Sodickson, A, Khorasani, R. Effect of clinical decision support on documented guideline adherence for head CT in emergency department patients with mild traumatic brain injury. J Am Med Inform Assoc 2014; 21: e347–e351.Google Scholar
Msaouel, P, Kappos, T, Tasoulis, A, Apostolopoulos, AP, Lekkas, I, Tripodaki, ES, et al. Assessment of cognitive biases and biostatistics knowledge of medical residents: A multicenter, cross-sectional questionnaire study. Med Educ Online 2014; 19: 23646.Google Scholar
Poses, RM, Cebul, RD, Wigton, RS. You can lead a horse to water – Improving physicians’ knowledge of probabilities may not affect their decisions. Med Decis Making 1995; 15: 65–75.Google Scholar
Ballard, DW, Rauchwerger, AS, Reed, ME, Vinson, DR, Mark, DG, Offerman, SR, et al. Emergency physicians’ knowledge and attitudes of clinical decision support in the electronic health record: A survey-based study. Acad Emerg Med 2013; 20: 352–360.Google Scholar
Brown, R, Furyk, J. Racial disparities in health care-emergency department management of minor head injury. Int J Emerg Med 2009; 2: 161–166.Google Scholar
Ingebrigtsen, T, Romner, B. Management of minor head injuries in hospitals in Norway. Acta Neurol Scand 1997; 95: 51–55.Google Scholar
Pines, JM, Hollander, JE, Isserman, JA, Chen, EH, Dean, AJ, Shofer, FS, et al. The association between physician risk tolerance and imaging use in abdominal pain. Am J Emerg Med 2009; 27: 552–557.Google Scholar
Diner, BM, Carpenter, CR, O’Connell, T, Pang, P, Brown, MD, Seupaul, RA, et al. Graduate medical education and knowledge translation: Role models, information pipelines, and practice change thresholds. Acad Emerg Med 2007; 14: 1008–1014.Google Scholar
Morton, MJ, Korley, FK. Head computed tomography use in the emergency department for mild traumatic brain injury: Integrating evidence into practice for the resident physician. Ann Emerg Med 2012; 60: 361–367.Google Scholar
Glasziou, P, Haynes, B. The paths from research to improved health outcomes. ACP J Club 2005; 142: A8–A10.Google Scholar
Af Geijerstam, JL, Britton, M. Mild head injury: Reliability of early computed tomographic findings in triage for admission. Emerg Med J 2005; 22: 103–107.Google Scholar
Shiwen, C, Chen, X, Lutao, Y, Hengli, T, Heli, C, Yan, G. Fatal deterioration of delayed acute subdural hematoma after mild traumatic brain injury: Two cases with brief review. Chin J Traumatol 2014; 17: 115–117.Google Scholar
Brenner, DJ, Hall, EJ. Cancer risks from CT scans: Now we have data, what next? Radiology 2012; 265: 330–331.Google Scholar
Pierce, DA, Preston, DL. Radiation-related cancer risks at low doses among atomic bomb survivors. Radiat Res 2000; 154: 178–186.Google Scholar
Preston, DL, Ron, E, Tokuoka, S, Funamoto, S, Nishi, N, Soda, M, et al. Solid cancer incidence in atomic bomb survivors: 1958–1998. Radiat Res 2007; 168: 1–64.CrossRefGoogle ScholarPubMed
Cardis, E, Vrijheid, M, Blettner, M, Gilbert, E, Hakama, M, Hill, C, et al. Risk of cancer after low doses of ionising radiation: Retrospective cohort study in 15 countries. BMJ 2005; 331: 77.Google Scholar
Brix, G, Nekolla, EA, Borowski, M, Nosske, D. Radiation risk and protection of patients in clinical SPECT/CT. Eur J Nucl Med Mol Imaging 2014; 41 (Suppl 1): S125–S136.Google Scholar
Brenner, DJ, Elliston, CD, Hall, EJ, Berdon, WE. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 2001; 176: 289–296.Google Scholar
Brenner, DJ, Hall, EJ. Computed tomography – An increasing source of radiation exposure. N Engl J Med 2007; 357: 2277–2284.Google Scholar
Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation; Board on Radiation Effects Research; Division on Earth and Life Studies; National Research Council of the National Academies. Health risks from exposure to low levels of ionizing radiation: BEIR VII phase 2. Washington, D.C.: National Academies Press, 2006.Google Scholar
ICRP. ICRP publication 105. Radiation protection in medicine. Ann ICRP 2007; 37: 1–63.Google Scholar
United Nations Scientific Committee on the Effects of Atomic Radiation. Effects of ionizing radiation: 2006 Report to the General Assembly, with scientific annexes. New York: United Nations Publications, 2008. Available at www.unscear.org/docs/publications/2006/UNSCEAR_2006_GA-Report.pdf.Google Scholar
Shah, DJ, Sachs, RK, Wilson, DJ. Radiation-induced cancer: A modern view. Br J Radiol 2012; 85: e1166–e1173.Google Scholar
Hendee, WR, O’Connor, MK. Radiation risks of medical imaging: Separating fact from fantasy. Radiology 2012; 264: 312–321.Google Scholar
Pearce, MS, Salotti, JA, Little, MP, McHugh, K, Lee, C, Kim, KP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: A retrospective cohort study. Lancet 2012; 380: 499–505.Google Scholar
Cohen, M. Cancer risks from CT radiation: Is there a dose threshold? J Am Coll Radiol 2013; 10: 817–819.Google Scholar
Raman, SP, Mahesh, M, Blasko, RV, Fishman, EK. CT scan parameters and radiation dose: Practical advice for radiologists. J Am Coll Radiol 2013; 10: 840–846.Google Scholar
Lambert, J, Mackenzie, JD, Cody, DD, Gould, R. Techniques and tactics for optimizing CT dose in adults and children: State of the art and future advances. J Am Coll Radiol 2014; 11: 262–266.Google Scholar
Ingebrigtsen, T, Romner, B. Routine early CT-scan is cost saving after minor head injury. Acta Neurol Scand 1996; 93: 207–210.Google Scholar
Gold, MR, Siegel, JE, Russel, LB, Weinstein, MC. Cost-effectiveness in health and medicine. New York: Oxford University Press, 1996.Google Scholar
Smits, M, Dippel, DW, Nederkoorn, PJ, Dekker, HM, Vos, PE, Kool, DR, et al. Minor head injury: CT-based strategies for management – A cost-effectiveness analysis. Radiology 2010; 254: 532–540.Google Scholar
Lee, LK, Monroe, D, Bachman, MC, Glass, TF, Mahajan, PV, Cooper, A, et al. Isolated loss of consciousness in children with minor blunt head trauma. JAMA Pediatr 2014; 168: 837–843.Google Scholar
Rehmani, R, Amanullah, S. Analysis of blood tests in the emergency department of a tertiary care hospital. Postgrad Med J 1999; 75: 662–666.Google Scholar
Koch, H, Van Bokhoven, MA, Ter Riet, G, Van Alphen-Jager, JT, Van Der Weijden, T, Dinant, GJ, et al. Ordering blood tests for patients with unexplained fatigue in general practice: What does it yield? Results of the VAMPIRE trial. Br J Gen Pract 2009; 59: e93–e100.Google Scholar
Koch, H, Van Bokhoven, MA, Ter, Riet G, Hessels, KM, Van Der Weijden, T, Dinant, GJ, et al. What makes general practitioners order blood tests for patients with unexplained complaints? A cross-sectional study. Eur J Gen Pract 2009; 15: 22–28.Google Scholar
Schloendorff v. The Society of New York Hospital (1914).Google Scholar
Ollivier, L, Apiou, F, Leclere, J, Sevellec, M, Asselain, B, Bredart, A, et al. Patient experiences and preferences: Development of practice guidelines in a cancer imaging department. Cancer Imaging 2009; 9 (Spec No A): S92–S97.Google Scholar
Lind, SE, Kopans, D, Good, MJ. Patients’ preferences for learning the results of mammographic examinations. Breast Cancer Res Treat 1992; 23: 223–232.Google Scholar
Baldwin, DM, Quintela, J, Duclos, C, Staton, EW, Pace, WD. Patient preferences for notification of normal laboratory test results: A report from the ASIPS Collaborative. BMC Fam Pract 2005; 6: 11.Google Scholar
Petrie, KJ, Muller, JT, Schirmbeck, F, Donkin, L, Broadbent, E, Ellis, CJ, et al. Effect of providing information about normal test results on patients’ reassurance: Randomised controlled trial. BMJ 2007; 334: 352.Google Scholar
Demaerel, P, Béatse, E, Roels, K, Thijs, V. Intermediate short-term outcomes after brain computed tomography and magnetic resonance imaging in neurology outpatients. Med Decis Making 2001; 21: 444–450.Google Scholar
Fang, C, Otero, HJ, Greenberg, D, Neumann, PJ. Cost–utility analyses of diagnostic laboratory tests: A systematic review. Value Health 2011; 14: 1010–1018.Google Scholar
McDonald, IG, Daly, J, Jelinek, VM, Panetta, F, Gutman, JM. Opening Pandora’s box: The unpredictability of reassurance by a normal test result. BMJ 1996; 313: 329–332.Google Scholar
Mushlin, AI, Mooney, C, Holloway, RG, Detsky, AS, Mattson, DH, Phelps, CE. The cost-effectiveness of magnetic resonance imaging for patients with equivocal neurological symptoms. Int J Technol Assess Health Care 1997; 13: 21–34.Google Scholar
Coulter, A. Partnerships with patients: The pros and cons of shared clinical decision-making. J Health Serv Res Policy 1997; 2: 112–121.Google Scholar
Ende, J, Kazis, L, Ash, A, Moskowitz, MA. Measuring patients’ desire for autonomy: Decision making and information-seeking preferences among medical patients. J Gen Intern Med 1989; 4: 23–30.Google Scholar
Robinson, A, Thomson, R. Variability in patient preferences for participating in medical decision making: Implication for the use of decision support tools. Qual Health Care 2001; 10 (Suppl 1): i34–i38.Google Scholar
Strull, WM, Lo, B, Charles, G. Do patients want to participate in medical decision making? JAMA 1984; 252: 2990–2994.Google Scholar
Beisecker, AE. Aging and the desire for information and input in medical decisions: Patient consumerism in medical encounters. Gerontologist 1988; 28: 330–335.Google Scholar
Vick, S, Scott, A. Agency in health care. Examining patients’ preferences for attributes of the doctor–patient relationship. J Health Econ 1998; 17: 587–605.Google Scholar
Coulter, A, Peto, V, Doll, H. Patients’ preferences and general practitioners’ decisions in the treatment of menstrual disorders. Fam Pract 1994; 11: 67–74.Google Scholar
Moskop, JC. Information disclosure and consent: Patient preferences and provider responsibilities. Am J Bioeth 2007; 7: 47–49; discussion W3–W4.Google Scholar
Lloyd, AJ. The extent of patients’ understanding of the risk of treatments. Qual Health Care 2001; 10 (Suppl 1): i14–i18.Google Scholar
Goske, MJ, Bulas, D. Improving health literacy: Informed decision-making rather than informed consent for CT scans in children. Pediatr Radiol 2009; 39: 901–903.Google Scholar
Lee, CI, Flaster, HV, Haims, AH, Monico, EP, Forman, HP. Diagnostic CT scans: institutional informed consent guidelines and practices at academic medical centers. AJR Am J Roentgenol 2006; 187: 282–287.Google Scholar
Cascade, PN. Resolved: That informed consent be obtained before screening CT. J Am Coll Radiol 2004; 1: 82–84.Google Scholar
Berlin, L. Shared decision-making: Is it time to obtain informed consent before radiologic examinations utilizing ionizing radiation? Legal and ethical implications. J Am Coll Radiol 2014; 11: 246–251.Google Scholar
Johnson v. Kokemoor, Supreme Court of Wisconsin (1996).Google Scholar
Phend, C. Parents want CT cancer risk info in ED. MedPage Today [Internet]. 2013 July 12, 2013. Available from: www.medpagetoday.com/EmergencyMedicine/EmergencyMedicine/40313.Google Scholar
Rodriguez, RM, Henderson, TM, Ritchie, AM, Langdorf, MI, Raja, AS, Silverman, E, et al. Patient preferences and acceptable risk for computed tomography in trauma. Injury 2014; 45: 1345–1349.Google Scholar
Sulmasy, DP. Physicians, cost control, and ethics. Ann Intern Med 1992; 116: 920–926.Google Scholar
Ladd, RE. Patients without choices: The ethics of decision-making in emergency medicine. J Emerg Med 1985; 3: 149–156.Google Scholar
Cloft, HJ, Joseph, GJ, Dion, JE. Risk of cerebral angiography in patients with subarachnoid hemorrhage, cerebral aneurysm, and arteriovenous malformation: A meta-analysis. Stroke 1999; 30: 317–320.Google Scholar

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