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Overutilization of Head Computed Tomography in Cases of Mild Traumatic Brain Injury: A Systematic Review and Meta-Analysis Publisher Pubmed



Rezaee M1 ; Nasehi MM2, 3 ; Effatpanah M4 ; Jabbaripour S5 ; Ghamkhar M6 ; Karami H7 ; Mehrizi R7 ; Torabi P8 ; Ghamkhar L9
Authors
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Authors Affiliations
  1. 1. Department of Orthopedics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Pediatric Neurology Research Center, Research Institute for Children’s Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  3. 3. Pediatric Neurology Department, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  4. 4. Pediatric Department, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, National Center for Health Insurance Research, Tehran, Iran
  5. 5. School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
  6. 6. Islamic Azad University Challus Branch, Mazandaran, Challus, Iran
  7. 7. National Center for Health Insurance Research, Tehran, Iran
  8. 8. Department of Radiology Arak, University of Medical Sciences, Arak, Iran
  9. 9. Physical Therapy, National Center for Health Insurance Research, Tehran, Iran

Source: Emergency Radiology Published:2024


Abstract

Head computed tomography (CT) is the preferred imaging modality for mild traumatic brain injury (mTBI). The routine use of head CT in low-risk individuals with mild TBI offers no clinical benefit but also causes notable health and financial burden. Despite the availability of related guidelines, studies have reported considerable rate of non-indicated head CT requests. The objectives were to provide an overall estimate for the head CT overutilization rate and to identify the factors contributing to the overuse. A systematic review of PubMed, Scopus, Web of Science, and Embase databases was conducted up to November 2023, following PRISMA and MOOSE guidelines. Two reviewers independently selected eligible articles and extracted data. Quality assessment was performed using a bias risk tool, and a random-effects model was used for data synthesis. Fourteen studies, encompassing 28,612 patients, were included, with 27,809 undergoing head CT scans. Notably, 75% of the included studies exhibited a moderate to high risk of bias. The overutilization rate for pediatric and adult patients was 27% (95% CI: 5–50%) and 32% (95% CI: 21–44%), respectively. An alternative rate, focusing on low-risk pediatric patients, was 54% (95% CI: 20–89%). Overutilization rates showed no significant difference between teaching and non-teaching hospitals. Patients with mTBI from falls or assaults were less likely to receive non-indicated scans. There was no significant association between physician specialty or seniority and overuse, nor between patients’ age or sex and the likelihood of receiving a non-indicated scan. Approximately one-third of head CT scans in mTBI cases are avoidable, underscoring the necessity for quality improvement programs to reduce unnecessary imaging and its associated burdens. © The Author(s), under exclusive licence to American Society of Emergency Radiology (ASER) 2024.
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