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Audit of trauma CT head requests – should we be adopting less stringent guidelines?
Poster Title: Audit of trauma CT head requests – should we be adopting less stringent guidelines?
Submitted on 15 Sep 2019
Author(s): Neel Jain, Simone Castagno & Jeremy Berger
Affiliations: Barnet Hospital, Royal Free London NHS Foundation Trust
This poster was presented at BIR Annual Congress 2019
Poster Views: 442
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Poster Information
Abstract: Introduction
CT head imaging (CTH) is the investigation of choice for head trauma and identification of intracranial bleeds. NICE offer guidelines for performing CTH in adults within 1 or 8 hours of head injury (1). Recent London Major Trauma System guidelines (2) call for a lower threshold for performing CTH in the elderly, considering the perceived number of missed acute or chronic subdural haematomas in presentations of ‘collapse’. The evidence for these less stringent guidelines is not well known.

A retrospective audit of Emergency Department CTH in a district general hospital in a 2-week period in December 2018 was performed (n=274). The clinical indications for the scans were compared against NICE guidelines. Patients were divided into 3 groups: those who met criteria for a scan within 1 hour, 8 hours or not at all. Those with non-trauma indications and age <18 were excluded. Positive findings in the scan reports were identified.

169 scans were analysed. Mean age was 68.
Key findings for each group:
- 1 hour (n=60, 35.5%): 3 intracranial bleeds, 3 ischaemic events
- 8 hours (n=50, 29.6%): 2 intracranial bleeds
- No criteria met (n=59, 34.9%): 2 intracranial bleeds, 2 ischaemic events

65.1% of trauma CTH requests met NICE guidelines, suggesting our centre is operating a less stringent policy than recommended. However, the number of significant findings appears no lower in the non-guideline compliant group. We therefore agree with the London Major Trauma System’s recommendations, that a lower threshold for scanning may be beneficial.
Summary: Audit of trauma CT head requests – should we be adopting less stringent guidelines?References: References
1. Head injury: assessment and early management, Clinical guideline [CG176], NICE, January 2014, updated June 2017,
2. Management of elderly major trauma patients – Second Edition, London Major Trauma System, December 2018,
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