There is no estimate of how many unnecessary imaging examinations are requested, performed, and reimbursed. Unofficially, professionals agree that the proportion is as high as one fourth to one third of all CT examinations performed in adult patients. Requests for CT imaging are driven by clinical need, patients' attitudes, fear of litigation and are subsequently limited by availability and reimbursement. Clinical decision support, appropriateness and indication criteria help clinicians to offer their patients the most reasonable of all options. However, they usually lack support in the legal system, which can make them rather inefficient.
In our present study entitled "Growing number of emergency cranial CTs in patients with head injury not justified by their clinical need" (Lambert et al. 2016), we investigated whether the rapidly growing numbers of emergency head CTs in patients after head injury is supported by their clinical need by comparing trends related to patients' condition, indication to perform imaging, and diagnostic yield. We documented decreases in the number of relevant findings, but increases in clinically unjustified requests (according to the NICE 2014 criteria) and proportions of inebriated patients. Broadly speaking, more examinations are performed which, instead, potentially harm the patients, decreasing the benefit-to-risk ratio of our diagnostic test. The overuse of CT has other implications as well, including radiation exposure, organisational issues, and increased costs. Despite this, we strongly believe that current practices will be difficult to change unless clinical decision support is not only endorsed, but legally supported.
Reference
Lambert L, Foltan O, Briza J, Lambertova A, Harsa P, Banerjee R4, Danes J (2016) Growing number of emergency cranial CTs in patients with head injury not justified by their clinical need. Wien Klin Wochenschr. 2016 Jun 20. [Epub ahead of print]
Value your people.
What would you single out as a career highlight?
Perhaps, establishing a new CT suite and endorsing excellence in the department.
If you had not chosen this career path you would have become a…?
... project manager in IT, perhaps.
What are your personal interests outside of work?
Family, sports, friends.
Your favourite quote?
Insanity is doing the same thing, over and over again, but expecting different results.
In our present study entitled "Growing number of emergency cranial CTs in patients with head injury not justified by their clinical need" (Lambert et al. 2016), we investigated whether the rapidly growing numbers of emergency head CTs in patients after head injury is supported by their clinical need by comparing trends related to patients' condition, indication to perform imaging, and diagnostic yield. We documented decreases in the number of relevant findings, but increases in clinically unjustified requests (according to the NICE 2014 criteria) and proportions of inebriated patients. Broadly speaking, more examinations are performed which, instead, potentially harm the patients, decreasing the benefit-to-risk ratio of our diagnostic test. The overuse of CT has other implications as well, including radiation exposure, organisational issues, and increased costs. Despite this, we strongly believe that current practices will be difficult to change unless clinical decision support is not only endorsed, but legally supported.
Reference
Lambert L, Foltan O, Briza J, Lambertova A, Harsa P, Banerjee R4, Danes J (2016) Growing number of emergency cranial CTs in patients with head injury not justified by their clinical need. Wien Klin Wochenschr. 2016 Jun 20. [Epub ahead of print]
Zoom On Lukas Lambert
Value your people.
What would you single out as a career highlight?
Perhaps, establishing a new CT suite and endorsing excellence in the department.
If you had not chosen this career path you would have become a…?
... project manager in IT, perhaps.
What are your personal interests outside of work?
Family, sports, friends.
Your favourite quote?
Insanity is doing the same thing, over and over again, but expecting different results.
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