Emergency head CT scan ordering and yield: A Malaysian experience

M. S. Ismail, M. F. Shahridan, Bee Hong Soon, A. A. Azhar, Abdulbari Bener

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: The aims of this study were to determine the emergency brain CT scan ordering rate in our emergency department and its positive yield rate; identify significant clinical factors as predictors for scan yield; and evaluate the need for a CT scanner in the emergency department and implementation of guidelines for emergency brain CT scan. Design: This was a retrospective study. Setting: The study was carried out in UKM hospital, Malaysia, from the 1 st of January to the 31 st of December 2003. Subjects and Methods: The study included all emergency brain CT scans done to 1,687 patients who visited the emergency department of the hospital. Of these patients, 1,088 samples with complete and clear clinical data were studied. The medical records were reviewed retrospectively for selecting these samples. Samples were grouped into trauma and non-trauma. The ordering rate and positive yield rate were calculated and clinical predictors for positive yield were analyzed using Chi-square test. Results: From the total 59,575 patients who visited the emergency department, head CT scan was likely to be helpful in 1,687 patients. A head CT study was requested for these patients. This resulted in an ordering rate of 2.83%. Of the 1,088 samples reviewed, 716 scans showed positive findings, giving the overall scan yield of 65.8%. Non-trauma cases had significant higher scan yield (70.5%). Age > 55 years was noted to have higher risk of positive scans in both groups, especially those presented with seizures. Other significant factors were dysarthria, limb weakness and facial asymmetry in non-trauma cases (all p < 0.05). Conclusion: The 2.83% ordering rate with 65.8% scan yield signifies the fact that emergency physicians in the study do not order unnecessary CT scans of the head. These findings were noteworthy and might suggest that we revise the request criteria for head CT. However, validated and locally applied CT scan guidelines should be developed and used in order to further enhance its cost-effectiveness in developing countries where resources are limited but its benefits in current and future settings can well be foreseen.

Original languageEnglish
Pages (from-to)151-155
Number of pages5
JournalJournal of Emergency Medicine, Trauma and Acute Care
Volume8
Issue number3
Publication statusPublished - Sep 2008
Externally publishedYes

Fingerprint

Emergencies
Head
Hospital Emergency Service
Brain
Guidelines
Facial Asymmetry
Dysarthria
Malaysia
Chi-Square Distribution
Developing Countries
Cost-Benefit Analysis
Medical Records
Seizures
Extremities
Retrospective Studies
Physicians
Wounds and Injuries

Keywords

  • CT scan
  • Emergency department
  • Ordering rate
  • Yield

ASJC Scopus subject areas

  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Emergency head CT scan ordering and yield : A Malaysian experience. / Ismail, M. S.; Shahridan, M. F.; Soon, Bee Hong; Azhar, A. A.; Bener, Abdulbari.

In: Journal of Emergency Medicine, Trauma and Acute Care, Vol. 8, No. 3, 09.2008, p. 151-155.

Research output: Contribution to journalArticle

Ismail, MS, Shahridan, MF, Soon, BH, Azhar, AA & Bener, A 2008, 'Emergency head CT scan ordering and yield: A Malaysian experience', Journal of Emergency Medicine, Trauma and Acute Care, vol. 8, no. 3, pp. 151-155.
Ismail, M. S. ; Shahridan, M. F. ; Soon, Bee Hong ; Azhar, A. A. ; Bener, Abdulbari. / Emergency head CT scan ordering and yield : A Malaysian experience. In: Journal of Emergency Medicine, Trauma and Acute Care. 2008 ; Vol. 8, No. 3. pp. 151-155.
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