Brent Griffith1, Phyllis Vallee2, Seth Krupp2, Melissa Jung3, Michelle Slezak2, Jumana Nagarwala2, C Patrick Loeckner2, Lonni R Schultz4, Rajan Jain5. 1. Department of Radiology, Henry Ford Health System, Detroit, Michigan. Electronic address: brentg@rad.hfh.edu. 2. Department of Emergency Medicine, Henry Ford Health System, Detroit, Michigan. 3. Department of Radiology, Henry Ford Health System, Detroit, Michigan. 4. Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan. 5. Department of Radiology, Henry Ford Health System, Detroit, Michigan; Department of Radiology, NYU Langone Medical Center, New York, New York.
Abstract
PURPOSE: The aim of this study was to determine the effect of a clinical education initiative on the appropriate utilization of screening cervical spine CT in the emergency department. The purpose was to assess if clinical education can produce stricter adherence to the ACR Appropriateness Criteria and improve the utilization of screening CT examinations in the emergency department. METHODS: Institutional review board approval was obtained for this HIPAA-compliant study. All adult patients presenting to a level 1 trauma center with blunt trauma prompting screening cervical spine CT were eligible. For each study, the requesting clinician completed a survey selecting all clinical indications. CT examinations were evaluated by a board-certified radiologist blinded to survey data. Results were compared with retrospective and prospective studies performed before the institution of the education initiative. RESULTS: Of the 388 cervical spine CT examinations performed, 12 (3.1%) were positive for acute cervical spine injury, compared to only 1.0% before the clinical education program (phase 2). Of the 376 examinations without injury, 13% met all 5 National Emergency X-Radiography Utilization Study criteria for nonimaging (down from 16.1% in phase 2), and 15 (4%) required no imaging when both National Emergency X-Radiography Utilization Study and abbreviated Canadian cervical spine rule criteria were applied. CONCLUSIONS: Implementation of a clinical education initiative resulted in improved adherence to ACR Appropriateness Criteria and improved clinical effectiveness of the studies by increasing fracture detection rate. Initiatives such as these could potentially influence imaging overutilization without burdening emergency department clinicians with excessive roadblocks to image ordering.
PURPOSE: The aim of this study was to determine the effect of a clinical education initiative on the appropriate utilization of screening cervical spine CT in the emergency department. The purpose was to assess if clinical education can produce stricter adherence to the ACRAppropriateness Criteria and improve the utilization of screening CT examinations in the emergency department. METHODS: Institutional review board approval was obtained for this HIPAA-compliant study. All adult patients presenting to a level 1 trauma center with blunt trauma prompting screening cervical spine CT were eligible. For each study, the requesting clinician completed a survey selecting all clinical indications. CT examinations were evaluated by a board-certified radiologist blinded to survey data. Results were compared with retrospective and prospective studies performed before the institution of the education initiative. RESULTS: Of the 388 cervical spine CT examinations performed, 12 (3.1%) were positive for acute cervical spine injury, compared to only 1.0% before the clinical education program (phase 2). Of the 376 examinations without injury, 13% met all 5 National Emergency X-Radiography Utilization Study criteria for nonimaging (down from 16.1% in phase 2), and 15 (4%) required no imaging when both National Emergency X-Radiography Utilization Study and abbreviated Canadian cervical spine rule criteria were applied. CONCLUSIONS: Implementation of a clinical education initiative resulted in improved adherence to ACRAppropriateness Criteria and improved clinical effectiveness of the studies by increasing fracture detection rate. Initiatives such as these could potentially influence imaging overutilization without burdening emergency department clinicians with excessive roadblocks to image ordering.
Authors: Annelie Slaar; M M Fockens; Junfeng Wang; Mario Maas; David J Wilson; J Carel Goslings; Niels Wl Schep; Rick R van Rijn Journal: Cochrane Database Syst Rev Date: 2017-12-07