(In)appropriate neurosurgical consultation

Thomas Arjan Van Essen, Jorn Jesse Heeringa, Jan Paul Muizelaar

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objectives: Whether or not a patient could benefit from a computed tomography (CT) scan and/or the evaluation by a neurosurgeon requires judgment by a clinician of the risk of clinical deterioration. To assess this clinical process we aimed to determine how many of the consultations to the Neurosurgical department (NSG) of UC Davis are appropriately indicated for neurosurgical input or management. Secondly, we investigated how CT is used in the University of California Davis Medical Center (UCDMC) in NSG consults of head injured patients compared to a validated and highly sensitive decision making tool, the Canadian CT Head Rule (CCHR). Patients and methods: Patients were enrolled in this prospective study if they presented to a department of UCDMC other than neurosurgery and when, consequently, the NSG was consulted. The emergency consultations were categorized into three groups: head injury, spine injury and others. Subsequently, the appropriateness of the consultations was evaluated based on the need for evaluation determined by the likelihood of clinically important intracranial lesions for head injury and by the likelihood of clinically important spinal cord injury or spinal cord instability for spine injury. Of the head injured patients with a CT scan the appropriateness of the scan was determined by way of the CCHR. Results: Between 21 July and 15 August 2008 99 consultations were included: 32 patients with head injuries, 29 with spine injuries, 34 with other diseases and 4 not sufficiently documented patients. 23 classified inappropriate, 69 appropriate and 7 remained unclassified. Of the head injured patients, 10 (31.2%) had gotten a CT scan that was classified inappropriate. Conclusion: NSG receives 3-4 requests for consultations per day from the other services of UCDMC, of which one is of questionable validity and one of the three CT scans for head injury is not necessary. These results suggest the use of the CCHR in UCDMC would improve patient care and could result in large health-care savings, while there would also be less radiation exposure.

Original languageEnglish (US)
Pages (from-to)775-780
Number of pages6
JournalClinical Neurology and Neurosurgery
Volume112
Issue number9
DOIs
StatePublished - Nov 2010

Fingerprint

Referral and Consultation
Head
Tomography
Craniocerebral Trauma
Spine
Wounds and Injuries
Neurosurgery
Spinal Cord Injuries
Spinal Cord
Decision Making
Patient Care
Emergencies
Prospective Studies
Delivery of Health Care

Keywords

  • Brain injuries
  • Decision aid
  • Humans
  • Prospective studies
  • Spinal injuries
  • Tomography
  • United States
  • X-ray computed

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

(In)appropriate neurosurgical consultation. / Van Essen, Thomas Arjan; Heeringa, Jorn Jesse; Muizelaar, Jan Paul.

In: Clinical Neurology and Neurosurgery, Vol. 112, No. 9, 11.2010, p. 775-780.

Research output: Contribution to journalArticle

Van Essen, Thomas Arjan ; Heeringa, Jorn Jesse ; Muizelaar, Jan Paul. / (In)appropriate neurosurgical consultation. In: Clinical Neurology and Neurosurgery. 2010 ; Vol. 112, No. 9. pp. 775-780.
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abstract = "Objectives: Whether or not a patient could benefit from a computed tomography (CT) scan and/or the evaluation by a neurosurgeon requires judgment by a clinician of the risk of clinical deterioration. To assess this clinical process we aimed to determine how many of the consultations to the Neurosurgical department (NSG) of UC Davis are appropriately indicated for neurosurgical input or management. Secondly, we investigated how CT is used in the University of California Davis Medical Center (UCDMC) in NSG consults of head injured patients compared to a validated and highly sensitive decision making tool, the Canadian CT Head Rule (CCHR). Patients and methods: Patients were enrolled in this prospective study if they presented to a department of UCDMC other than neurosurgery and when, consequently, the NSG was consulted. The emergency consultations were categorized into three groups: head injury, spine injury and others. Subsequently, the appropriateness of the consultations was evaluated based on the need for evaluation determined by the likelihood of clinically important intracranial lesions for head injury and by the likelihood of clinically important spinal cord injury or spinal cord instability for spine injury. Of the head injured patients with a CT scan the appropriateness of the scan was determined by way of the CCHR. Results: Between 21 July and 15 August 2008 99 consultations were included: 32 patients with head injuries, 29 with spine injuries, 34 with other diseases and 4 not sufficiently documented patients. 23 classified inappropriate, 69 appropriate and 7 remained unclassified. Of the head injured patients, 10 (31.2{\%}) had gotten a CT scan that was classified inappropriate. Conclusion: NSG receives 3-4 requests for consultations per day from the other services of UCDMC, of which one is of questionable validity and one of the three CT scans for head injury is not necessary. These results suggest the use of the CCHR in UCDMC would improve patient care and could result in large health-care savings, while there would also be less radiation exposure.",
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