scholarly journals P037: Adherence to the Canadian CT Head Rule in a Nova Scotian emergency and trauma centre

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S77-S78
Author(s):  
C. LeBlanc ◽  
A. Sampalli ◽  
S. Campbell
Keyword(s):  
Nova Scotia ◽  
Head Injuries ◽  
Clinical Decision ◽  
Trauma Centre ◽  
Choosing Wisely ◽  
Current Status ◽  
Chart Audit ◽  
Charles V ◽  
Retrospective Audit ◽  
Ct Head

Introduction: Choosing Wisely Nova Scotia (CWNS), an affiliate of Choosing Wisely Canada™ (CWC), aims to address unnecessary care and testing through literature-informed lists developed by various disciplines. CWC has identified unnecessary head CTs among the top five interventions to question in the Emergency Department (ED). Zyluk (2015) determined the Canadian CT Head Rule (CCHR) as the most effective clinical decision rule in adults with minor head injuries. To better understand the current status of CCHR use in Nova Scotia, we conducted a retrospective audit of patient charts at the Charles V. Keating Emergency and Trauma Center, in Halifax, Nova Scotia. Methods: Our mixed methods design included a literature review, retrospective chart audit, and a qualitative audit-feedback component with participating physicians. The chart audit applied the guidelines for adherence to the CCHR and reported on the level of compliance within the ED. Analysis of qualitative data is included here, in parallel with in-depth to contextualize findings from the audit. Results: 302 charts of patients having presented to the surveyed site were retrospectively reviewed. Of the 37 cases where a CT head was indicated as per the CCHR, a CT was ordered 32 (86.5%) times. Of the 176 cases where a CT head was not indicated, a CT was not ordered 155 (88.1%) times. Therefore, the CCHR was followed in 187 (87.8%) of the total 213 cases where the CCHR should be applied. Conclusion: Our study reveals adherence to the CCHR in 87.8% of cases at this ED. Identifying contextual factors that facilitate or hinder the application of CCHR in practice is critical for reducing unnecessary CTs. This work has been presented to the physician group to gain physician engagement and to elucidate enablers and barriers to guideline adherence. In light of the frequency of CT heads ordered EDs, even a small reduction would be impactful.

scholarly journals LO001: The prevalence of low back pain in the emergency department: a systematic review and primary study in the Charles V. Keating Emergency and Trauma Centre, Halifax, Nova Scotia, Canada

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S30-S30 ◽  
Author(s):  
J. Edwards ◽  
J. Hayden ◽  
K. Magee ◽  
M. Asbridge
Keyword(s):  
Systematic Review ◽  
Emergency Department ◽  
Low Back Pain ◽  
Back Pain ◽  
Nova Scotia ◽  
Trauma Centre ◽  
Emergency Department Visits ◽  
Primary Study ◽  
Low Back ◽  
Charles V

Introduction: Low back pain (LBP) may be having a significant impact on emergency departments (ED) around the world. Two analyses conducted in the USA and Australia suggest that LBP is one of the leading causes of emergency department visits. However, in the peer-reviewed literature, there has been limited focus on the prevalence and management of back pain in the ED setting. Furthermore, the applicability of the available research to our local ED setting is unclear. Methods: This project includes two studies to investigate the prevalence of LBP in the ED: 1. a comprehensive systematic review of the published literature to gather a comprehensive and global perspective about the prevalence of LBP in the ED setting, and 2. a retrospective cross sectional analysis using six years of data from our local ED, the Charles V. Keating Emergency and Trauma Centre, Halifax, Nova Scotia. Results: Searches from multiple databases including PubMed (392 citations), resulted in 3024 citations, of which 20 studies were found to have prevalence data for LBP. Studies were reported between 2001–2015 and used mixed methods of data collection, including electronic databases, surveys and patient charts. Ranges for prevalence estimates were 1.9% to 17% of patient visits. Results indicated there are many gaps in the literature, for example research in rural EDs and in Canada. In our primary study, we have identified a sample of 10 000 patients presenting with LBP to our local ED. Analysis of this data will be completed prior to the CAEP conference. Conclusion: This project is the first systematic review; comprehensive search strategy to examine the prevalence of LBP in the ED. It is also the first project to assess the prevalence of LBP in a Canadian ED. Results from this study will inform healthcare providers, as well as administrative and policy decision-makers, of the global and local impact of LBP in the ED, and will identify opportunities for further research to enhance care pathways of patients suffering from LBP.

scholarly journals LO66: Did the Choosing Wisely Canada campaign work? A retrospective analysis of its impact on emergency department imaging utilization for head injuries

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S50-S51
Author(s):  
S. Masood ◽  
L.B. Chartier
Keyword(s):  
Emergency Department ◽  
Head Injuries ◽  
Tertiary Care ◽  
Significant Proportion ◽  
Emergency Department Visits ◽  
Choosing Wisely ◽  
Significant Difference ◽  
Imaging Utilization ◽  
Ct Head ◽  
The Impact

Introduction: Head injuries are a commonly encountered presentation in emergency departments (ED) and the Choosing Wisely Canada (CWC) campaign was released in June 2015 in an attempt to decrease imaging utilization for patients with minor head injuries. The impact of the CWC campaign on imaging utilization for head injuries has not been explored in the ED setting. In our study, we describe the characteristics of patients with head injuries presenting to a tertiary care academic ED and the impact of the CWC campaign on CT head utilization. Methods: This retrospective cohort study used linked databases from the province of Ontario, Canada to assess emergency department visits with a primary diagnosis of head injury made between June 1, 2014 and Aug 31, 2016 at the University Health Network in Toronto, Canada. We examined the number of visits during the study period, the proportion of patients that had a CT head performed before and after the release of the CWC campaign, as well as mode of arrival, and disposition. Results: There were 4,322 qualifying visits at our site during the study period. The median presenting age was 44.12 years (IQR 27.83,67.45), the median GCS was 15 (IQR 15,15) and the majority of patients presenting had intermediate acuity (CTAS 3). Overall, 43.17% of patients arrived via ambulance, 49.24 % of patients received a CT head and 10.46% of patients were admitted. Compared to patients presenting before the CWC campaign release, there was no significant difference in the rate of CT heads after the CWC (50.41% vs 47.68%, P=0.07). There were also no significant differences between the two groups in mode of arrival (ambulance vs ambulatory) (42.94% vs 43.48%, P=0.72) or admission rates (9.85% vs 11.26%, P=0.15). However, more patients belonged to the high acuity groups (CTAS 1 or 2) in the post CWC campaign release group (12.98% vs 8.11% P<0.001). Conclusion: Visits for head injuries make up a significant proportion of total ED visits and approximately half of these patients receive CT imaging in the ED. The CWC campaign did not seem to impact imaging utilization for head injuries in the 14 months following its launch. Further efforts, including local quality improvement initiatives, are likely needed to increase adherence to its recommendation and reduce imaging utilization for head injuries.

scholarly journals Choosing Wisely Canada®: Five tests, procedures and treatments to question in Emergency Medicine

CJEM ◽  
2017 ◽  
Vol 19 (S2) ◽  
pp. S9-S17 ◽  
Author(s):  
Amy H. Y. Cheng ◽  
Sam Campbell ◽  
Lucas B. Chartier ◽  
Tom Goddard ◽  
Kirk Magee ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Head Injuries ◽  
Clinical Decision ◽  
Choosing Wisely ◽  
Emergency Physicians ◽  
Spinal Imaging ◽  
Canadian Association ◽  
Frequency Of Use ◽  
Expert Working Group ◽  
Adults And Children

AbstractObjectivesChoosing Wisely Canada (CWC) is an initiative to encourage patient-physician discussions about the appropriate, evidence based use of medical tests, procedures and treatments. We present the Canadian Association of Emergency Physicians’ (CAEP) top five list of recommendations, and the process undertaken to generate them.MethodsThe CAEP Expert Working Group (EWG) generated a candidate list of 52 tests, procedures, and treatments in emergency medicine whose value to care was questioned. This list was distributed to CAEP committee chairs, revised, and then divided and randomly allocated to 107 Canadian emergency physicians (EWG nominated) who voted on each item based on: action-ability, effectiveness, safety, economic burden, and frequency of use. The EWG discussed the items with the highest votes, and generated the recommendations by consensus.ResultsThe top five CAEP CWC recommendations are: 1) Don’t order CT head scans in adults and children who have suffered minor head injuries (unless positive for a validated head injury clinical decision rule); 2) Don’t prescribe antibiotics in adults with bronchitis/asthma and children with bronchiolitis; 3) Don’t order lumbosacral spinal imaging in patients with non-traumatic low back pain who have no red flags/pathologic indicators; 4) Don’t order neck radiographs in patients who have a negative examination using the Canadian C-spine rules; and 5) Don’t prescribe antibiotics after incision and drainage of uncomplicated skin abscesses unless extensive cellulitis exists.ConclusionsThe CWC recommendations for emergency medicine were selected using a mixed methods approach. This top 5 list was released at the CAEP Conference in June 2015 and should form the basis for future implementation efforts.

scholarly journals 31 Head home: a prospective cohort study of a nurse led paediatric head injury clinical decision tool at a district general hospital

2020 ◽  
Vol 37 (12) ◽  
pp. 853-854
Author(s):  
Patrick Aldridge ◽  
Heather Castle ◽  
Emma Russell ◽  
Clare Phillips ◽  
Richard Guerrero-Luduena ◽  
...  
Keyword(s):  
Head Injury ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Head Injuries ◽  
Clinical Decision ◽  
Decision Tool ◽  
Intracranial Injury ◽  
Multi Centre Study ◽  
Paediatric Head Injury ◽  
Published Evidence

Aims/Objectives/BackgroundObjectivesTo assess if application of a nurse-led paediatric head injury clinical decision tool would be safe compared to current practice.Background>700,000 children attend UK hospitals’ each year with a head injury. Research indicates <1% undergo neurosurgical intervention. No published evidence for nurse-led discharge of paediatric head injuries exists.Methods/DesignMethods – All paediatric (<17 years) patients with head injuries presenting to our Emergency department (ED) 1st May to 31st October 2018 were prospectively screened by a nurse using a mandated electronic ‘Head Injury Discharge At Triage’ questionnaire (HIDATq). We determined which patients underwent computed tomography (CT) brain and whether there was a clinically important intracranial injury or re-presentation to ED. The negative predictive value of the screening tool was assessed. We determined what proportion of patients could have been sent home from triage using HIDATq.Results/ConclusionsResults - Of 1739 patients screened; 61 had CTs performed due to head injury (6 abnormal) with a CT rate of 3.5% and 2% re-presentations. Of the entire cohort, 1052 screened negative. 1 CT occurred in this group showing no abnormalities. Of those screened negative: 349/1052 (33%) had ‘no other injuries’ and 543/1052 (52%) had ‘abrasions or lacerations’. HIDATq’s negative predictive value for CT was 99.9% (95% Confidence interval (CI) 99.4–99.9%) and 100% (CI 99.0–100%) for intracranial injury. The positive predictive value of the tool was low. Five patients screened negative and re-presented within 72hrs but did not require CT imaging.Conclusion - A negative HIDATq appears safe in our ED. Potentially 20% (349/1739) of all patients with head injuries presenting to our department could be discharged by nurses at triage with adequate safety netting advice. This increases to 50% (543/1739) if patients with lacerations or abrasions were treated and discharged at triage. A large multi-centre study is required to validate the tool.

scholarly journals Assessing the risk for major injuries in equestrian sports

2018 ◽  
Vol 4 (1) ◽  
pp. e000408 ◽  
Author(s):  
Lara Krüger ◽  
Maike Hohberg ◽  
Wolfgang Lehmann ◽  
Klaus Dresing
Keyword(s):  
Surgical Therapy ◽  
Lower Limb ◽  
Head Injuries ◽  
Trauma Centre ◽  
The Body ◽  
Body Region ◽  
Older Individuals ◽  
Horse Riding ◽  
Limb Injuries ◽  
Prevention Programmes

Background/aimHorse riding is a popular sport, which bears the risk of serious injuries. This study aims to assess whether individual factors influence the risk to sustain major injuries.MethodsRetrospective data were collected from all equine-related accidents at a German Level I Trauma Centre between 2004 and 2014. Logistic regression was used to identify the risk factors for major injures.Results770 patients were included (87.9% females). Falling off the horse (67.7%) and being kicked by the horse (16.5%) were the two main injury mechanisms. Men and individuals of higher age showed higher odds for all tested parameters of serious injury. Patients falling off a horse had higher odds for being treated as inpatients, whereas patients who were kicked had higher odds for a surgical therapy (OR 1.7) and intensive care unit/intermediate care unit (ICU/IMC) treatment (OR 1.2). The head was the body region most often injured (32.6%) and operated (32.9%). Patients with head injuries had the highest odds for being hospitalised (OR 6.13). Head or trunk injuries lead to the highest odds for an ICU/IMC treatment (head: OR 4.37; trunk: OR 2.47). Upper and lower limb injuries showed the highest odds for a surgical therapy (upper limb: OR 2.61; lower limb: OR 1.7).ConclusionRisk prevention programmes should include older individuals and males as target groups. Thus a rethinking of the overall risk assessment is necessary. Not only horseback riding itself, but also handling a horse bears a relevant risk for major injuries. Serious head injures remain frequent, serious and an important issue to be handled in equestrians sports.

Clinical Decision Support Systems

2021 ◽  
pp. 1-7
Author(s):  
Andreas Teufel ◽  
Harald Binder
Keyword(s):  
Decision Support ◽  
Decision Support Systems ◽  
Clinical Decision Support ◽  
Health Care Providers ◽  
Support Systems ◽  
Medical Knowledge ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Current Status ◽  
Care Providers

<b><i>Background:</i></b> By combining up-to-date medical knowledge and steadily increasing patient data, a new level of medical care can emerge. <b><i>Summary and Key Messages:</i></b> Clinical decision support systems (CDSSs) are an arising solution to handling rich data and providing them to health care providers in order to improve diagnosis and treatment. However, despite promising examples in many areas, substantial evidence for a thorough benefit of these support solutions is lacking. This may be due to a lack of general frameworks and diverse health systems around the globe. We therefore summarize the current status of CDSSs in medicine but also discuss potential limitations that need to be overcome in order to further foster future development and acceptance.

Trauma: Head and Facial Trauma

2015 ◽  
Author(s):  
Christopher R. Tainter ◽  
Raghu Seethala
Keyword(s):  
Decision Aids ◽  
Head Injuries ◽  
Antiplatelet Agent ◽  
Clinical Decision ◽  
Return To Play ◽  
Facial Trauma ◽  
Left Frontal Lobe ◽  
Mild Tbi ◽  
Computed Tomographic ◽  
Le Fort Classification

Head and facial trauma includes a wide variety of heterogeneous injuries that vary according to cause, severity, management, and outcomes. These injuries are classified as head injuries (the scalp, skull, and brain) and facial injuries (to the eyes, bony structures, nose, mouth, teeth, tongue, and glands and the accompanying nerves, muscles, and vasculature). This review covers the epidemiology, anatomy, assessment and stabilization, diagnosis, treatment and disposition, and outcomes for traumatic brain injury (TBI), scalp and cranial vault trauma, ocular trauma, and facial trauma. Figures show computed tomographic scans showing a large left frontal lobe intraparenchymal hemorrhage, a traumatic subarachnoid hemorrhage, a subdural hematoma, a right occipital epidural hematoma, and a left orbital floor “blowout” fracture; an illustration of the brain herniation syndromes; the anatomy of the globe; and the Le Fort classification scheme of midface fractures. Tables list the Glasgow Coma Scale, clinical decision aids for computed tomography after mild TBI, the PECARN clinical decision rule for children with mild TBI, the graduated return to play protocol, and anticoagulant and antiplatelet agent reversal. This review contains 8 highly rendered figures, 5 tables, and 75 references.

The Development and Implementation of Patient Safety Information Systems (PSIS)

2011 ◽  
pp. 2054-2072
Author(s):  
Jeongeun Kim
Keyword(s):  
Patient Safety ◽  
Developmental Stages ◽  
Safety Information ◽  
Clinical Decision ◽  
Quality Of Healthcare ◽  
Essential Elements ◽  
Current Status ◽  
General Description ◽  
Safety Issues ◽  
Future Goals

This chapter presents the overview of the current status and developmental stages of the PSIS technology and consensus around the patient safety issues as they emerge, grow, and mature globally. The first section gives the general description of the patient safety reporting system (PSRS), and then provides the brief summary of 23 patient safety information classifications and terminologies to date. In the next section, the development of the international classification of patient safety (ICPS) is overviewed, which evolved from the local to an international level by the joint initiatives of WHO. The essential elements of the PSIS and the clinical decision support system (CDSS) functionalities are explained to make the future goals of PSIS clearer. The patient safety indicator (PSI) is explained in a separate section, which provides the opportunity to assess the incidence of adverse events and in-hospital complications using administrative data found in the typical discharge record. The ultimate goals of PSIS and PSI are to improve the quality of healthcare and ensure patient safety.

Head Trauma

2018 ◽  
pp. 8-11
Author(s):  
Todd W. Thomsen
Keyword(s):  
Blood Pressure ◽  
Head Injury ◽  
Key Management ◽  
Rapid Assessment ◽  
Decision Rules ◽  
Clinical Decision ◽  
Loss Of Consciousness ◽  
Ct Head ◽  
Neurosurgical Intervention

Head injury is often associated with other serious trauma. Clinical decision rules such as the Canadian CT Head Rule can guide clinicians in the judicious use of neuroimaging, which can then guide the appropriate course of treatment. Rapid assessment of patients requiring neurosurgical intervention is critical, as is appropriate management of blood pressure and hypoxia. This chapter considers a case study of blunt head injury with loss of consciousness of a skier in the backcountry, The author addresses patient history, physical exam, differential diagnoses, clinical course, and key management steps. The patient’s condition relative to the Canadian CT Head Rule is specifically discussed.

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