Computed tomography use in minor head injury: attitudes and practices of emergency physicians, neurosurgeons, and radiologists in Turkey

BACKGROUND: We aimed to determine the attitudes and practices of emergency physicians (EPs), neurosurgeons, and radiologists in Turkey regarding computed tomography (CT) use for adults with minor head injury (MHI).
METHODS: This cross-sectional study was conducted between August 2015 and October 2016 after obtaining the approval of the institutional ethical committee. The purpose of this study was disclosed to the participants prior to beginning the survey. The study was performed conducting a questionnaire via e-mail on three groups of participants including EPs, neurosurgeons, and radiologists. Participants comprised academic staff at university hospitals as well as department chiefs, specialists, and residents working at university, government, and private hospitals, all of whom are in charge of evaluating MHI patients.
RESULTS: A total of 607 participants including 201 (33.1%) EPs, 179 (29.5%) neurosurgeons, and 227 (37.4%) radiologists responded to the survey; 31% of the participants reported awareness and 27.3% reported use of head CT rules in MHI. Awareness and use of the rules were most prominent in EPs group, while the lowest rates were observed in radiologists group (p<0.01). The leading factors inhibiting the use of head CT rules in MHI stated by EPs were medicolegal anxiety (73.6%), expectations of patients and/or patient relatives (72.6%), and time constraints (44.3%). The leading factors stated by neurosurgeons were medicolegal anxiety (60.9%) and expectations of patient and/or patient relatives (46.4%); “not being consulted in the decision-making process to obtain CT in MHI” (65.6%) and medicolegal anxiety (49.8%) were the leading factors stated by radiologists.
CONCLUSION: The results of our study show that many physicians in Turkey do not have favorable attitudes regarding head CT rules in MHI. Medicolegal anxiety, expectations of patient and/or patient relatives, time constraints, wide availability of CT, and lack of adequate education on radiation protection or on patient dose from imaging are the common reasons for this practice pattern.

Minör kafa travmasýnda bilgisayarlý tomografi kullanýmý: Türkiye’deki acil týp hekimleri, beyin cerrahlarý ve radyologlarýn tutum ve uygulamalarý

AMAÇ: Türkiye’deki acil týp hekimleri, beyin cerrahlarý ve radyologlarýn, minör kafa travmasýnda (MKT) bilgisayarlý tomografi (BT) kullanýmý ile ilgili tutum ve davranýþlarýný belirlemektir.
GEREÇ VE YÖNTEM: Çalýþma acil týp hekimleri, beyin cerrahlarý ve radyologlara anket formu uygulanarak gerçekleþtirildi.
BULGULAR: Ankete 201 acil týp hekimi, 179 beyin cerrahý ve 227 radyolog dahil olmak üzere toplam 607 katýlýmcý yanýt verdi. Minör kafa travmasýnda beyin BT kurallarý ile ilgili genel farkýndalýk oraný %31 olarak bulundu. Katýlýmcýlarýn %27.3’ü kurallarý uyguladýðýný bildirdi. Kurallarýn farkýndalýðý ve kullanýmý acil týp hekimi grubunda en belirgin iken en düþük oranlar radyologlar grubunda gözlendi (p<0.01). Acil týp hekimlerinin MKT’de beyin BT kurallarýný kullanmalarýný engelleyen baþlýca etkenler; mediko legal kaygý (%73.6), hastalarýn ve/veya hasta yakýnlarýnýn beklentileri (%72.6) ve zaman kýsýtlamalarý (%44.3) idi. Beyin cerrahlarýnýn belirttikleri baþta gelen faktörler; mediko legal kaygý (%60.9) ve hasta ve/veya hasta yakýnlarýnýn beklentileri (%46.4) idi. Radyologlar tarafýndan belirtilen baþlýca etken “karar verme sürecinde danýþýlmamaktadýr” (%65.6) idi.
TARTIÞMA: Çalýþmamýzýn sonuçlarý, Türkiye’de birçok hekimin MKT’de beyin BT kurallarý ile ilgili olumlu tutumlarý olmadýðýný göstermektedir. Mediko legal kaygý, hastanýn ve/veya hasta yakýnlarýnýn beklentileri, zaman kýsýtlamalarý, BT’nin yaygýnlýðý ve týbbi görüntülemede radyasyondan korunma veya hasta radyasyon dozu konularýnda eðitim yetersizliði bu uygulama þekli için ortak nedenler olarak tanýmlanmaktadýr.