The use of CT in the management of minor head injuries in Queenstown
Jennifer Keys 1 , Louise Venter 1 , Garry Nixon 21 Lakes District Hospital, 20 Douglas St, Frankton, Queenstown, New Zealand
2 Rural Postgraduate Programme, University of Otago, Dunedin, New Zealand
Correspondence to: Jennifer Keys, Lakes District Hospital, 20 Douglas St, Frankton, Queenstown, New Zealand. Email: jennifer.keys@southerndhb.govt.nz
Journal of Primary Health Care 9(2) 162-166 https://doi.org/10.1071/HC16029
Published: 30 June 2017
Journal Compilation © Royal New Zealand College of General Practitioners 2017.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Abstract
AIM: This study retrospectively reviewed the management of head injury at Lakes District Hospital in Queenstown, New Zealand. The aim is to describe the management of minor head injury with particular reference to the current Traumatic Brain Injury guidelines of the New Zealand Guidelines Group.
METHODS: We identified all patients with head injury as a primary diagnosis who were seen in the Emergency Department at Lakes District Hospital during 2013–2015. We recorded clinical criteria indicating need for computed tomography (CT) scanning according to current guidelines for management of minor head injury.
RESULTS: A total of 883 patients were seen with head injury as their primary diagnosis: 280 patients aged >15 years had a minor head injury that met current criteria for immediate CT scanning. Of these, 66 (23.6%) actually had a CT head scan.
CONCLUSION: The rate of CT head scanning for minor head injury in Queenstown does not comply with current New Zealand guidelines.
KEYWORDS: Rural health; craniocerebral trauma; healthcare disparities; guideline adherence
References
[1] Statistics New Zealand. 2013 Census population and dwelling tables – Queenstown-Lakes District. [cited 2016 December 23] Available from: www.stats.govt.nz/~/.../Census/2013%20Census/data.../population.../queenstown-lakes.[2] Statistics New Zealand Commercial Accommodation Monitor. [cited 2016 April 20] Available from: http://www.queenstownnz.co.nz/Media/Statistics2_md/.
[3] Accident Compensation Commission injury statistics tool. [cited 2016 March 14] Available from: http://www.acc.co.nz/about-acc/statistics/injury-statistics/index.htm#.
[4] Stiell IG, Wells GA, Vandemheen K, et al. The Canadian CT Head rule for patients with minor head injury. Lancet 2001; 357 1391–6.
| The Canadian CT Head rule for patients with minor head injury.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M3mtlGntw%3D%3D&md5=937447344b5e447629991df20ed1c7c9CAS |
[5] Injury TB. Diagnosis, Acute Management and Rehabilitation. New Zealand Guidelines Group. July 2006. [cited 2016 February 12] Available from: www.acc.co.nz/PRD_EXT_CSMP/groups/.../wim2_059414.pdf.
[6] Nixon G, Samaranayaka A, de Graaf B, et al. Geographic disparities in the utilisation of computed tomography scanning services in southern New Zealand. Health Policy 2014; 118 222–8.
| Geographic disparities in the utilisation of computed tomography scanning services in southern New Zealand.Crossref | GoogleScholarGoogle Scholar |
[7] Kaji AH, Schriger D, Green S. Looking through the retrospectoscope: reducing bias in emergency medicine chart review studies. Ann Emerg Med 2014; 64 292–8.
| Looking through the retrospectoscope: reducing bias in emergency medicine chart review studies.Crossref | GoogleScholarGoogle Scholar |
[8] Smits M, Dippel DW, de Haan GG, et al. External validation of the Canadian CT Head Rule and the New Orleans Criteria for CT Scanning in patients with minor head injury. JAMA 2005; 294 1519–25.
| External validation of the Canadian CT Head Rule and the New Orleans Criteria for CT Scanning in patients with minor head injury.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2MXhtVGqsLjP&md5=48a4a4fca6a627e4777c407652985e7eCAS |
[9] van der Naalt J, Hew JM, van Zomeren AH, et al. Computed tomography and magnetic resonance imaging in mild to moderate head injury: early and late imaging related to outcome. Ann Neurol 1999; 46 70–8.
| Computed tomography and magnetic resonance imaging in mild to moderate head injury: early and late imaging related to outcome.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1MzivVajuw%3D%3D&md5=df115da7a26f14114789919d2da48907CAS |
[10] Müller K, Ingebrigtsen T, Wilsgaard T, et al. Prediction of time trends in recovery of cognitive function after mild head injury. Neurosurgery 2009; 64 698–704.
| Prediction of time trends in recovery of cognitive function after mild head injury.Crossref | GoogleScholarGoogle Scholar |
[11] Yanagawa Y, Sakamoto T. Significance of minor traumatic lesions in focal head injuries. J Clin Neurosci 2011; 18 520–3.
| Significance of minor traumatic lesions in focal head injuries.Crossref | GoogleScholarGoogle Scholar |
[12] Theadom A, Parmar P, Jones K, et al. Frequency and impact of recurrent traumatic brain injury in a population-based sample. J Neurotrauma 2015; 32 674–81.
| Frequency and impact of recurrent traumatic brain injury in a population-based sample.Crossref | GoogleScholarGoogle Scholar |
[13] Orlovska S, Pedersen MS, Benros ME, et al. Head injury as risk factor for psychiatric disorders: A nationwide register-based follow-up study of 113,906 persons with head injury. Am J Psychiatry 2014; 171 463–9.
| Head injury as risk factor for psychiatric disorders: A nationwide register-based follow-up study of 113,906 persons with head injury.Crossref | GoogleScholarGoogle Scholar |
[14] Merkens BJ, Mowbray RD, Creeden L, et al. A rural CT scanner: Evaluating the effect on local health care. Can Assoc Radiol J 2006; 57 224–31.
[15] Nixon G, Samaranayaka A, de Graaf B, et al. The impact of a rural scanner in overcoming urban versus rural disparities in the utilisation of computed tomography. Aust J Rural Health 2015; 23 150–4.
| The impact of a rural scanner in overcoming urban versus rural disparities in the utilisation of computed tomography.Crossref | GoogleScholarGoogle Scholar |
[16] Rural Expert Advisory Group to the Ministry of Health. Implementing the Primary Health Care Strategy in Rural New Zealand 2002. [cited 2016 December 23] Available from: http://www.moh.govt.nz/notebook/nbbooks.nsf/0/5e56a47c1768d27ecc256c190076e807/$FILE/RuralPrimaryHealthStrategyImplementation.pdf.
[17] Australian Institute of Health and Welfare. Rural, regional and remote health: indicators of health status and determinants of health. 31 March 2008. [cited 2016 December 23] Available from: http://www.aihw.gov.au/publication-detail/?id=64424680768libID=6442468074.
[18] Pong RW, Desmeules M, Lagacé C. Rural-urban disparities in health: how does Canada fare and how does Canada compare with Australia? Aust J Rural Health 2009; 17 58–64.
| Rural-urban disparities in health: how does Canada fare and how does Canada compare with Australia?Crossref | GoogleScholarGoogle Scholar |
[19] Anderson TJ, Saman DM, Lipsky MS, Lutfiyya MN. A cross-sectional study on health differences between rural and non-rural U.S. counties using the County Health Rankings. BMC Health Serv Res 2015; 15 441
| A cross-sectional study on health differences between rural and non-rural U.S. counties using the County Health Rankings.Crossref | GoogleScholarGoogle Scholar |
[20] Singh R, Goebel LJ. Rural disparities in cancer care: A review of its implications and possible interventions. W V Med J 2016; 112 76–82.
[21] Fleet R, Archambault P, Plant J, Poitras J. Access to emergency care in rural Canada: should we be concerned? CJEM 2013; 15 191–3.
[22] Fearnley D, Lawrenson R, Nixon G. ‘Poorly defined’: unknown unknowns in New Zealand Rural Health. N Z Med J 2016; 129 77–81.
