Check the Necessity of Performing A CT Scan of the Brain in Patients with Mild Trauma

Received: 11-Nov-2024, Manuscript No. CSRP-24-147805; Editor assigned: 13-Nov-2024, Pre QC No. CSRP-24-147805 (PQ); Reviewed: 27-Nov-2024, QC No. CSRP-24-147805; Revised: 17-Jun-2025, Manuscript No. CSRP-24-147805 (R); Published: 24-Jun-2025

Abbreviations

CT: Computed Tomography; ICU: Intensive Care Unit

Introduction

Computed tomography scans show highly accurate tissues; therefore, it is a valuable tool for detecting abnormalities in the brain or spinal cord [1]. In general, tomography scans help doctors diagnose brain tumors, strokes, sinusitis, aortic artery dilatation, chest infections, and diseases of organs such as the liver, kidneys, and lymph nodes. Also with this method, injuries and, internal bleeding are quickly identified This early diagnosis on a CT scan allows the doctor to start treatment as soon as possible [2]. CT scan of the skull in patients with head traumplaysay an important role in identifying injury; in moderate to severe brain injury, a CT scan is arguably the best way to get information about the intracranial complications of a head injury [3]. Researchers have cited several reasons why doctors are increasingly asking for CT scans of patients. Some researchers attribute this to the lack of clarity and clarity of the existing instructions or the lack of information and concern of some physicians about the requirements for performing a CT scan of the head. This will ultimately lead to more physicians using diagnostic tests such as CT scans to ensure their behavior and documentation to deal with any possible legal problems [4]. The emergency department is one of any hospital's most important and essential organs in response to disasters and accidents [5]. The emergency department plays a critical role in providing immediate medical care to patients and prompt medical interventions at all times of the day and all days of the year. Its performance can have a great impact on other departments and patient satisfaction. Out of the same patients referred to the emergency department, only a few are admitted to different wards of the hospital. Therefore, how to provide services in an emergency is a symbol of the general state of hospital services [6]. The effectiveness of the emergency department is evaluated according to the waiting time. The speed of providing services in medical centers, especially emergency, is of special importance to provide services, to reduce moand mortality and disabilities.

In a medical emergency, seconds and minutes are important to the patient, and these times may determine the distance between life and death. The waiting time of patients to provide care and treatment services is one of the important and influential factors in the satisfaction of emergency patients. Prolonged waiting time and the stay of patients in the emergency room can lead to a negative attitude of the community towards the hospital and care providers [7]. Also, according to the Global Brain Injury Guidelines, all patients referred to a trauma emergency center should be examined in less than 15 minutes. And CT scan of the head should be done less than an hour after requesting a CT scan [8]. Since the request for unnecessary scan scan increases the waiting time of patients in addition, the need for the nurse to accompany the patient to perform a CT scan, completion of the patient file by then use, and documentation have increased the workload of the emergency department nurses. Also, increasing the employment rate of beds in this sector prevents the provision of services to clients in order of priority [9]. This delays the diagnosis of brain damage. This issue can cause irreversible and lifethreatening effects on this group of patients. On the other hand; CT scan has disadvantages such as high cost for the patients and hospital; the risk of radiation and patient dissatisfaction. Therefore; due to the importance of the issue in trauma patients; the researchers decided to investigate the frequency and cause of CT scans to avoid doing this diagnostic unnecessarily in cases where it is not necessary to do it and prevent possible damage and financial burden for the patients and hospital.

Materials and Methods

This study is a cross-sectional clinical trial study in which 445 patients referred to the Emergency Department of Taleghani Hospital in Kermanshah city; who had been referred to the Emergency Department due to trauma and head injury were studied as research units. Confirmation of the patient's trauma by the doctor and requesting a CT scan of the skull was a condition for admission to the study and not requesting a CT scan was a condition for exclusion from the study. Sampling in this study was done by simple random method among trauma patients who were asked for a CT scan of the brain. In this study; the reason for requesting a CT scan of the skull from the requesting physician was asked through an interview when requesting this procedure. In this part of the f s, the variables were described by using descriptive statistics including frequency; mean percentage, and standard deviation. Then the research hypotheses and in other words; the relationships between the variable of hospitalization time and other study variables were examined using independent t-test and Chi square. Fisher exact test was used in conditions where Chi square assumptions were not met. The data collection tool was a two-part questionnaire the first included demographic information and the second part included clinical information of the research units. Data were collected based on interviews with the treating physician and treatment process documentation and patient information was recorded in the prepared checklist and then analyzed by SPSS software.

Results

Description of the studied variable

Demographic variables and other variables were described using descriptive statistics including average; standard deviation; frequency and percentage.

Level of consciousness: According to the Table 1, the level of consciousness for patients at level 13 was 28/3% and 71/5% of them were at level 15.

Table 1. Frequency distribution of consciousness level variables.

Reason for referral: According to this Table 2, out of 445 patients; 36/6% were referred to the emergency department due to a car accident and 0/7% due to epilepsy.

Table 2. Frequency distribution of patients because of referral.

Age: According to the Table 3 the age group of 12-30 years had the highest frequency and the age group over 70 years had the lowest frequency.

Table 3. Frequency distribution of age group of patients.

Sex: According to the Table 4, 445 patients were studied 257 of them were male and 188 were female. Therefore; the percentage of male clients is more women man.

Table 4. Frequency distribution of patients by sex

Pathological symptoms: According to the Table 5, 88/3% of the patients referred were asymptomatic and only 0/9% of them presented with meningitis symptoms.

Table 5. frequency distribution of the studied samples by pathological symptoms.

Clinical symptoms: According to the Table 6, the highest frequency of clinical symptoms was related to headache, and 36% were presented with symptoms such as headache; nausea, and dizziness.

Table 6. Frequency distribution of samples by clinical signs.

Reason for requesting a CT scan: According to the Table 7, 99/6% of the requests for CT scans were from the doctor and only 2 out of 445 people (4.0%) had performed CT scans at their request.

Table 7. Frequency distribution of samples by CT scan applicant.

Reason for discharge: According to the Table 8, about 73% of the patients were discharged at the request of the doctor and 0.9% of the patients escaped.

Table 8. Frequency distribution of the studied samples according to the cause of the discharge.

Underlying disease: According to the Table 9, about 84% of patients had no underlying disease and 1/1% had asthma.

Table 9. Frequency distribution of samples by an underlying disease.

Addiction or allergies: According to the Table 10, about 92% of patients were not addicted or allergic and about 8% of the samples answered positively.

Table 10. Frequency distribution of samples according to the presence or absence of addiction or sensitivity.

Duration of hospitalization: According to the Table 11, 73/4% of patients were discharged from the hospital within 24 hours and only 26/6% of patients were hospitalized for more than 24 hours.

Table 11. Frequency distribution of patients according to the length of hospital stay.

Hospitalization in other wards of the hospital: According to the Table 12, 74% of patients were hospitalized in the outpatient emergency department of the hospital and 5/2% were admitted to the ICU 1 ward.

Table 12. Frequency distribution of patients according to the hospitalization in other wards of the hospital.

Investigation of research hypotheses

In this part of the study, the relationship between the duration of hospitalization and other variables was examined using an independent t-test, Chi square. It should be noted that wherever the Chi square test default was not met, Fisher's exact test was used.

Investigating the relationship between the level of consciousness and duration of hospitalization.

According to the Table 13 from 122 patients, that were at the level of consciousness 13, 75 persons were hospitalized for more than 24 hours. While from 306 patients with a level of consciousness of 15, only 38 were hospitalized for more than 24 hours.

Table 13. Investigating the relationship between the level of consciousness and duration of hospitalization using Fisher's exact test.

Investigating the relationship between the reason for referral and duration of hospitalization

According to the Table 14, there was a statistically significant relationship between the reason for referral and duration of hospitalization stay at the level of 0.05. For example, out of 43 patients referred because of conflict, 18 persons (approximately 42%) were hospitalized for more than 24 hours. Of the 81 patients who presented because of a collision with a hard object, only 8 (approximately 10%) were hospitalized for more than 24 hours.

Table 14. Investigating the relationship between the reason for referral and length of hospital stay using Fisher's exact test

Investigating the relationship between age and duration of hospitalization

According to the average age Table 15, patients hospitalized for more than 24 hours are more than those hospitalized for a maximum of 24 hours. However, this mean difference was not statistically significant at the level of 0.05.

Table 15. Investigating the relationship between age and duration of hospitalization stay using an independent t-test.

Investigating the relationship between gender and duration of hospitalization

According to the Table 16, there is no statistically significant relationship between gender and duration of hospitalization.

Table 16. Investigating the relationship between gender and duration of hospitalization using the Chi-square test.

Investigating the relationship between pathological symptoms and duration of hospitalization

According to the Table 17, the result of Fisher's exact test was significant at the level of 0.05. That is, there is a statistically significant relationship between the reason for referral and the length of hospital stay. For example; 18 persons with mild symptoms were hospitalized for 24 hours. while of the 20 injured 8 persons were hospitalized for more than 24 hours.

Table 17. Evaluation of the relationship between pathological symptoms and duration of hospitalization using Fisher's exact test.

Evaluation of the relationship between clinical symptoms and duration of hospitalization

According to the Table 18, there was a statistically significant relationship between the reason for referral and the duration of hospitalization. As can be seen, the proportion of samples who were hospitalized for more than 24 hours is not homogeneous in different groups.

Table 18. Evaluation of the relationship between clinical symptoms and duration of hospitalization.

Investigating the relationship between the duration of hospitalization stay and the person requesting a CT scan

According to the Table 19, no significant relationship was observed between the length of hospital stay and the person requesting the CT scan.

Table 19. Investigating the relationship between the duration of hospitalization stay and the person requesting a CT scan.

Investigating the relationship between discharge cause and duration of hospitalization stay using Fisher's exact test

According to the Table 20, there was a significant relationship between the cause of the drawing and the duration of hospitalization.

Table 20. Investigating the relationship between discharge cause and duration of hospitalization stay using Fisher's exact test.

Investigating the relationship between underlying disease and duration of hospitalization using the Fisher test

According to the Table 21, there was no statistically significant relationship between the underlying disease and the duration of hospitalization.

Table 21. Investigating the relationship between underlying disease and duration of hospitalization stay using Fisher's exact test.

Investigating the relationship between the duration of hospitalization and sensitivity or addiction

According to the Table 22, about a quarter of the samples who were not allergic or addicted were hospitalized for more than 24 hours and 14 of the 31 patients with allergies or addictions were hospitalized for more than 24 hours.

Table 22. Investigating the relationship between duration of hospitalization and sensitivity or addiction using the Chi-square test.

Investigating the relationship between hospitalization time and hospitalization in other wards

According to the Table 23, there is a statistically significant relationship between the variable’s duration of hospitalization and hospitalization in other wards.

Table 23. Investigating the relationship between the duration of hospitalization and hospitalization in other wards.

Discussion

This study aimed to evaluate abnormal findings in patients with mild cranial trauma referred to the hospital with a level of consciousness of 13 to 15. In the present study, 445 patients with mild trauma were studied, 126 persons (28.3%) were at the level of consciousness 13, 1 person (0.2%) at the level of consciousness 14, and 318 persons (5/5) 71%) were at level 15 of consciousness. According to a study conducted by Stiell in Canada, the average level of consciousness 15 in patients with mild trauma was 79%. Studies show that road accidents with 36.6% have the highest rate of cranial damage in patients and Zhu. H study shows this consistency in the findings. According to this study, the three factors of accidents 14/1%, falling 5.6%, and blows 9.1% (collision of objects-conflict) were the most common reasons for patients to refer to medical centers. Findings of 445 patients with an average age of 34.73 show that 57.8% of patients were male and 42.2% were female. Also, these statistics and the results of various types of research show that the reason for referral is directly related to different cultural and geographical factors of the research place. Conflict is also one of the most important social issues in any society, the number of which is higher in men than women. Which depends on various cultural and social factors such as residence, employment, race, marital status, age, ethnicity, etc., and the results of the present study are consistent with the Miller study, in which 61% of the clients are men. Of this number of male and female patients, most of the clients are under 30 years old and in the second decade of their lives. Researchers believe that the reason for such similarities in demographic findings is a more male activity in socio-economic fields, high-risk behaviors in men, and the activity of the under 40 age group compared to other age groups. Also, different social groupings can sometimes lead to conflict among the population and violence. According to the results of the present study, 11.6% of the patients had abnormal CT scans, which showed different brain lesions. This is related to the results of Smits studies which show 9.9% of brain damage. According to the results of Abdul Latip's study, lowering the Glasgow standard score from 15 to (14-13) increases the risk of brain damage in patients, and these people need more cranial tomography. Decreased level of consciousness is also directly related to the incidence of nausea and vomiting in patients, which can be an important factor for cranial Xrays in patients. However, since patients with GCS 15 do not have an urgent need for initial measures, it is recommended that brain scans of these patients be performed if there are symptoms such as loss of consciousness, nausea, vomiting, severe tenderness, etc. According to research by Roka, et al. The most common symptoms in patients with cranial trauma were nausea and vomiting (57%) and headache (43%). Among 445 patients in this study, 52.8% of patients had nausea and vomiting and 46.1% had headaches these people required CT scans due to specific clinical symptoms. But in other people, the lack of specific symptoms causes ionizing radiation damage in these people. The results of the present study also show that people who did not have severe clinical symptoms did not have a problem with their tomography scan and did not need a CT scan and the doctor's order was only to document the patient's file. Given that performing a CT scan in the early hours after head trauma can lead to the diagnosis of life-threatening factors in the patient and is effective in reducing mortality due to cranial trauma CT scans can be very costly for patients and their families. Also, ionizing radiation from CT scans can cause cancer in patients. Therefore, in addition to reducing the level of consciousness in these people, it is recommended to pay attention to other clinical symptoms such as nausea, vomiting, severe tenderness, etc. In this study, out of 445 patients studied, 99.6% of patients underwent CT scans according to the doctor's instructions. This is due to hospital protocols to ensure that doctors diagnose and protect themselves from the dangers of misdiagnosis and exposure to the law. In the study of Lindor, et al., 60 legal cases were examined in which the reason for the complaint was the lack of a doctor's order to perform a CT scan, which shows the importance of documenting the cases of patients with skull trauma that performing CT scan increase physicians' ability to respond to such cases. In a study by John. You et al., Participating physicians often cited fear of misdiagnosis and the resulting legal condemnation, often at the request of the patient or the patient's companions, as the most important reason for requesting a CT scan. Researchers have argued that people in the community have expressed unrealistic views about the ability of advanced medical equipment, including CT scans for correct diagnosis. Among the 445 patients in this study, 73.4%, equal to 315 of them, were discharged in the first 24 hours and did not need hospital services. Of these 315, 313, i.e., 73.1% of patients with The doctor's orders released. This indicates that CT scans were not needed in these patients. The doctor has performed CT scans for various reasons, such as fear of complaining, hospital instructions, confirmation or rejection of brain lesions, as well as the speed of diagnosis. Research has shown that the risk of underlying disease increases the risk of injury in patients with cranial trauma. Also in the present study, 10.1% of patients had underlying hypertension, 2% had epilepsy and 1.1% had asthma. Among the patients who were examined, 26.6% of them were hospitalized for more than 24 hours, this issue depends on various factors such as the patient's symptoms, her consent to attend or leave the hospital, the reason for referral, and the severity of the injury. Also, this number of hospitalized patients shows that performing CT scans in hospitals is due to the completion of the case and the prevention of legal problems and their subsequent consequences. However, if there are strong and clear protocols according to which the doctor can diagnose the patient's condition based on the symptoms and request a CT scan if necessary and not face legal problems, the number of unnecessary CT scans can be reduced, and protected patients from the dangers of CT scans. Also, the presence of experienced physicians in the emergency department, due to their greater ability in early diagnosis and familiarity with dangerous symptoms, helps to reduce the number of CT scans requested.

Conclusion

After obtaining the test results, it is important to thoroughly assess the patient's condition and take measures to avoid any potential risks. However, the absence of well-defined protocols and the uncertainty of physicians in their diagnoses have led to an increase in the number of unnecessary CT scans performed on qualified individuals.

Limitations

In the present study, due to the formation of a new file for each patient in the re-visit, we were not able to investigate this issue in the event of subsequent patient visits. In some parts, due to incomplete file information, the number of some findings has decreased slightly.

Ethics Approval and Consent to Participate

This study was approved by the Ethics Committee of Kermanshah University of Medical Sciences in Iran with the ethical code IR ethics ID KUMS. REC (1398.1093).

Consent for Publication

Not applicable.

Availability of Data and Materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Competing Interests

The author declares that there are no competing interests.

Funding

Not applicable.

Authors' Contributions

Contributed to the conception of the work, data collection, conducting of the study, data analysis and interpretation of the study, revising the draft, approval of the final version of the manuscript, and agreed to all aspects of the work, TM: Conceptualization and data curation, SS: Formal analysis and writing–original draft, AM: Investigation, AT: Methodology, MJ. V: Project administration and supervision, HV: Resources, HM and HH: Visualization, MGH: Writing–review and editing.

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Citation: Mahvar, Tayabeh, Ali Malekkhatabi, Hanieh Mohammadi, and Hadisalsadat Hosseini, et al. "Check the Necessity of Performing A CT Scan of the Brain in Patients with Mild Trauma." Clin Schizophr Relat Psychoses 19 (2025).

Copyright: © 2025 Mahvar T, et al. This is an open-access article distributed under the terms of the creative commons attribution license which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.