Document Type : Research Paper
Department of Anesthesiology and critical care Medicine, school of medicine, zahedan university of medical sciences, zahedan, Iranrtment
Department of Radiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Department of General surgery,Tehran university of Medical sciences, Tehran, Iran
Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Background and Objective: Traumatic brain injury (TBI) is one of the primary causes of trauma-related mortality and disability; while clinically important cases could be diagnosed by brain CT scan, high rates of false negative have raised cost-effectiveness controversies. To review the epidemiology of negative brain CT scans and their economic burden on healthcare systems.
Method: This was a narrative review of literature, querying the online databases of PubMed, Science Direct, and Web of Science for cost-effectiveness studies of brain CT scan in mild TBI.
Results: Based on our review, 12 studies were found to evaluate the cost-effectiveness of CT scans for mild trauma patients. Among the 6 studies with a study design of cost-effectiveness model, had more long time cost analysis based on the possibility of missing the diagnosis of an important CT scan finding for TBI patient and almost all of those studies revealed that requesting CT scan for all of the mild trauma patients is better than missing cases, even by costs. Some other studies compared conservative management versus early CT scan in the highest level of evidence, Norlund et al. revealed that CT scan of all patients is more cost-effective than observation of patients in ED. A high rate of false-positive results for the applied recommendations in most reviewed studies might address the weakness of existing guidelines in preventing unnecessary CT requests and also a high rate of true negative might show the incompatibility of clinicians with guidelines. These are all imposing high unnecessary costs on hospitals and the healthcare system. Traumatic brain injury if undiagnosed could lead to mortality and disability that contribute to much more economic losses than performing a negative CT scan. But, the exorbitance rate of these negative CT scans is not justifiable.
Conclusion: Due to the high cost of CT scan technologies and limited resources, there is an urgent need for systematic approaches to optimal allocation of CT requests for traumatic brain injury; but currently, requesting CT scans for most patients is favored over missing any important TBI; while further studies are needed to draw a conclusion.