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Summary
Adequacy of head computed tomography requests in mild traumatic brain injury: a need for change
Pedro Ángel de Santos Castro1, Carlos del Pozo Vegas1, David de Santos Sánchez2, Francisco Martín Rodríguez2,3, Ancor Sanz García4-6
Affiliation of the authors
1Servicio de Urgencias, Hospital Clínico Universitario de Valladolid, Valladolid, Spain. 2Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain. 3Unidad Móvil de Emergencias Valladolid I, Gerencia de Emergencias Sanitarias, Gerencia Regional de Salud de Castilla y León (SACYL), Spain. 4Facultad de Ciencias de la Salud, Universidad de Castilla La Mancha, Talavera de la Reina, Toledo, Spain. 5Grupo de Innovación Tecnológica Aplicada a la Salud (ITAS), Facultad de Ciencias de la Salud, Universidad de Castilla La Mancha, Talavera de la Reina, Toledo, Spain. 6Grupo de Evaluación de Cuidados de Salud (ECUSAL), Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Talavera de la Reina, Toledo, Spain.
DOI
Quote
de Santos Castro PA, del Pozo Vegas C, de Santos Sánchez D, Martín Rodríguez F, Sanz García A. Adequacy of head computed tomography requests in mild traumatic brain injury: a need for change. Rev Esp Urg Emerg. 2025;4:148–53
Summary
OBJECTIVE. To assess the degree of adherence to clinical protocols and clinical practice guidelines for mild traumatic brain injury (mTBI)—NICE, New Orleans, Canadian, and MAPAC—in requesting computed tomography (CT) scans. Additionally, estimate the impact that introducing the SEMES clinical protocol for the management of mTBI based on intracranial injury biomarkers (ICIB)
would have on an emergency department (ED) of a tertiary referral center.
MATERIAL AND METHODS. We conducted retrospective observational study reviewing the health records of patients aged $ 16 years treated in our hospital ED for mTBI over a 6-month period.
RESULTS. We studied a total of 545 patients, 377 (69.2%) of whom received CT scans, revealing 56 (10.3%) intracranial lesions (ICL). Statistically significant associations with the finding of ICL included the presence of mTBI symptoms or signs [13.6% vs 2.4%; OR 8.7 (95%CI, 2.7-28.6); p < 0.001], age ≥ 65 years [13.1% vs 5.5%; OR, 2.6 (95%CI, 1.3-5.1); p = 0.006], and dangerous mechanism of injury [17.6% vs 9.1%; OR, 2.1 (95%CI, 1.1-4.2); p = 0.029]. Adherence to clinical practice guidelines was low. Clinical practice showed predictive values for finding ICL similar to those using the guidelines. We estimate that applying the SEMES protocol would have saved 24 (4.4%) CT scans vs current clinical practice.
CONCLUSIONS. Strict adherence to mTBI guidelines in our department would not reduce CT requests, and the use of ICIB would only do so slightly. We need to explore under which situations ICIB determination is most useful to improve the efficiency of EDs.
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