Reducing computed tomography (CT) imaging for adults with minor traumatic brain injuries in the emergency department

Non-contrast computed tomography (CT) is an important imaging modality in the care of adult patients with acute medical problems and injuries in an emergency department. These images can initiate timely and lifesaving interventions. One area where the utility of CT scanning has been debated is after minor traumatic brain injury (mTBI) or concussion in adults. This condition is defined as a direct blow to the head, neck, or body resulting in impulsive forces being transmitted to the brain causing alteration in mental status, with symptoms developing immediately or over time, that may include a loss of consciousness.1 Common mechanisms include sports and recreational activities, falls, motor vehicle crashes, and physical assault.2 In most clinical presentations of mTBI, the neurological examination is normal and the Glasgow Coma Scale (GCS) is 13-15. GCS <13 designates a more severe injury.

According to a CDC report, fewer than 10% of adult patients in the US experiencing a mTBI suffer serious brain injuries that require hospitalisation or surgery, and most are discharged from the emergency department based on clinical assessment alone.3 A prospective study of patients with minor head injuries in Canada found that 5% had clinically important brain injuries and 0.4% required neurosurgical intervention. Similarly, a US study of patients with minor head injuries seen in emergency departments found that 3.5% had …