Emergency Department Campaign Reduces CT Use Without Identified Missed Injuries

Unnecessary head and cervical spine computed tomography (CT) in low-risk trauma patients exposes them to avoidable radiation, prolongs emergency department stays, and increases healthcare costs. Beyond these consequences for individual patients, imaging overuse strains capacity in crowded emergency departments, where timely assessment and triage are essential. These pressures highlight the need for approaches that reduce low-value imaging while preserving diagnostic safety. In response, emergency medicine physicians implemented a targeted quality-improvement campaign designed to safely reduce CT use in low-risk trauma patients.

At the University of Cincinnati (Cincinnati, OH, USA), emergency departments at University of Cincinnati Medical Center and West Chester Hospital deployed a multifaceted campaign grounded in validated clinical decision rules for head and neck imaging. The team reinforced these rules through continuing education for emergency medicine providers. They embedded the decision rules into the electronic health record to guide test ordering at the point of care. Patient‑facing handouts addressed expectations when clinicians determined a CT scan was not indicated.

A peer‑reviewed study in the Western Journal of Emergency Medicine reported outcomes over 23 months. The campaign avoided an estimated 3,542 head and cervical spine CT scans, prevented 6,021.4 millisieverts of radiation exposure, and cut approximately 14,168 hours of waiting time, based on about four hours per forgone scan. Patient health care costs were reduced by roughly $6.2 million, assuming about $1,750 per CT. A structured safety review identified no patient harm and no missed injuries.

Clinical decision rules are central to emergency medicine training and help clinicians determine which trauma patients require head or neck CT. These rules identify low-risk patients, including some with concussions, who can be managed without imaging, while flagging features that warrant further evaluation. High-risk indicators include falls from a height, ejection from motor vehicles, limb weakness or numbness, blood in the ear, and symptoms such as vomiting or confusion.

The campaign demonstrated how these principles can be applied in a high-volume setting. University of Cincinnati Medical Center, the region’s only academic medical center and Level I adult trauma center, has an 81-bed emergency department that frequently operates at capacity. The findings indicate that evidence-based reductions in imaging can be sustained even in busy trauma centers facing substantial demand.

“We do not miss serious injuries if you follow these guidelines. There is no downside. Indeed, we did not find a single missed injury when we reviewed our data,” said Thompson, an associate professor of clinical emergency medicine and the director of quality improvement and patient safety in the College of Medicine’s Department of Emergency Medicine.

“Not everyone with a head or neck injury needs a CT scan. Some do; some don’t. We strive to provide the right care for every patient, and we have the tools to make those decisions,” said Thompson.

Related Links
University of Cincinnati College of Medicine
University of Cincinnati Medical Center