A prospective cluster-randomized trial to implement the Canadian CT Head Rule in emergency departments
| Autor: | R. Douglas McKnight, Jeremy M. Grimshaw, Iain MacPhail, Howard Lesiuk, Jamie C. Brehaut, Ian G. Stiell, Amit Shah, Carol J. Bennett, Robert J. Brison, Brian H. Rowe, Scott Ross, Tim Rutledge, Jonathan Dreyer, Brian R. Holroyd, George A. Wells, Jacques S. Lee, Catherine M. Clement, Eric Letovsky, Jeffrey J. Perry, Mary A. Eisenhauer, Michael J. Schull, Urbain Ip |
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| Rok vydání: | 2010 |
| Předmět: |
Adult
Male Canada medicine.medical_specialty Adolescent Referral MEDLINE Sensitivity and Specificity law.invention Randomized controlled trial law Knowledge translation Confidence Intervals medicine Cluster Analysis Craniocerebral Trauma Humans Prospective Studies Cluster randomised controlled trial Prospective cohort study Aged Aged 80 and over business.industry Research General Medicine Decision rule Middle Aged medicine.disease Confidence interval Practice Guidelines as Topic Emergency medicine Female Medical emergency Tomography X-Ray Computed business |
| Zdroj: | Canadian Medical Association Journal. 182:1527-1532 |
| ISSN: | 1488-2329 0820-3946 |
| Popis: | Background: The Canadian CT Head Rule was developed to allow physicians to be more selective when ordering computed tomography (CT) imaging for patients with minor head injury. We sought to evaluate the effectiveness of implementing this validated decision rule at multiple emergency departments. Methods: We conducted a matched-pair cluster-randomized trial that compared the outcomes of 4531 patients with minor head injury during two 12-month periods (before and after) at hospital emergency departments in Canada, six of which were randomly allocated as intervention sites and six as control sites. At the intervention sites, active strategies, including education, changes to policy and real-time reminders on radiologic requisitions were used to implement the Canadian CT Head Rule. The main outcome measure was referral for CT scan of the head. Results: Baseline characteristics of patients were similar when comparing control to intervention sites. At the intervention sites, the proportion of patients referred for CT imaging increased from the “before” period (62.8%) to the “after” period (76.2%) (difference +13.3%, 95% CI 9.7%–17.0%). At the control sites, the proportion of CT imaging usage also increased, from 67.5% to 74.1% (difference +6.7%, 95% CI 2.6%–10.8%). The change in mean imaging rates from the “before” period to the “after” period for intervention versus control hospitals was not significant ( p = 0.16). There were no missed brain injuries or adverse outcomes. Interpretation: Our knowledge–translation-based trial of the Canadian CT Head Rule did not reduce rates of CT imaging in Canadian emergency departments. Future studies should identify strategies to deal with barriers to implementation of this decision rule and explore more effective approaches to knowledge translation. (ClinicalTrials.gov trial register no. NCT00993252) |
| Databáze: | OpenAIRE |
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