Author: Tao, Yung Sang
Title: Establishment of local CT head rule to reduce patient radiation dosage in emergency department
Advisors: Ying, Tin Cheung Michael (HTI)
Degree: DHSc
Year: 2023
Subject: Head -- Tomography
Hospitals -- Emergency services -- Management
Hong Kong Polytechnic University -- Dissertations
Department: Faculty of Health and Social Sciences
Pages: xiv, 108 pages : color illustrations
Language: English
Abstract: Background and Objectives
The study aimed to investigate the feasibility of setting up a computed tomography (CT) head selective rule for minor head injury patients in an accident and emergency department in Hong Kong. The study also verified the reliability of the rule in terms of its effectiveness and accuracy so that it may be used as a quick referencing guideline to use in routine clinical practice for reducing unnecessary CT head examinations, and reducing unnecessary radiation exposure dosage to patients.
The phase one study retrospectively reviewed the frequently seen signs and symptoms of minor head injury patients. The data were classified as various risk factors, and a chi-square test was employed to test the correlations between individual risk factor and positive CT head scan result. The phase two study applied the determined risk factors to justify the requested CT head scan prospectively. The multiple logistic regression model was employed to predict the correlation between CT head scan result and the risk factors. The risk factors with a high probability to yield a positive CT head scan result were selected to devise the CT head selective rule.
Based on 2001 minor head injury patients who had a cranial CT scan in the phase one study, 127 (6.3%) patients had positive CT results. The risk factor of Glasgow Coma Scores lower than 15, patients aged above 65, loss of consciousness, and episodes of vomiting after minor head injury were the most frequent signs and symptoms related to a positive CT result. The phase two study applied three additional risk factors, including alcohol intoxication, an open head wound, and the ambulatory ability of the patient after a minor head injury. A total of 387 patients were included in this phase, and 40 (10.3%) were presented with a positive CT result. All patients with a positive CT result were presented with one or more risk factors. However, 33% of the CT scans were performed on patients with no risk factors. Thus, an avoidable radiation dosage would have been possible if the CT head rule was followed correctly.
To protect patients from potential harmful ionizing radiation, the local CT head rule should be applied for minor head injury patients to avoid unnecessary CT scanning.
Rights: All rights reserved
Access: restricted access

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