Research In Action

Our Minds Matter team at CIRP@CHOP recently published a brief report in Academic Emergency Medicine that indicates head computed tomography (CT) scans are ordered too frequently for emergency department patients ultimately diagnosed with concussions, which is counter to best practice recommendations.

In a cross-sectional analysis of the nationwide Emergency Department Sample (NEDS), we identified patients of all ages with concussion diagnoses for years 2006-2011 to better understand the contemporary epidemiology of concussion and rates of CT scans in order to help inform best practice education efforts.

We learned that 0.5 percent of visits in the NEDS database received concussion diagnoses and that the national incidence rate of concussion visits increased 22.6 percent from 2006 to 2011. There were 580,573 visits in 2006 vs. 743,994 visits in 2011 and increases were seen in all age groups. 

The majority of this increase in concussion visits was likely attributed to a greater awareness and recognition of concussion symptoms and their consequences, rather than to more injuries. However, this could not be specifically determined from the dataset and requires further investigation.

CT Scans Not Indicated for Suspected Concussions

Of greater significance, there was a corresponding increase in the rate of head CT scans ordered, even though the overall injury severity of patients’ concussion decreased during this same time period.

This trend is concerning since a concussion cannot be identified with conventional neuroimaging, and CT scans should only be considered if a more serious and clinically important brain injury is suspected. There are many reasons to minimize CT use including unnecessary cost, time in the emergency department, and exposure to ionizing radiation. Validated prediction rules should be used to limit CT utilization.

In the brief report, we recommend that emergency medicine providers review the evidence-based guidelines for neuroimaging and develop strategies to minimize unnecessary exposure to CT scans for minor head injury as providers more frequently diagnose concussions. These strategies might also include prepared messaging and education for patients and parents who request a CT when it may not be indicated. For more information on our pediatric concussion care research, click here.