Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2010 Oct 5;182(14):1527-32.
doi: 10.1503/cmaj.091974. Epub 2010 Aug 23.

A prospective cluster-randomized trial to implement the Canadian CT Head Rule in emergency departments

Ian G Stiell  1 , Catherine M Clement, Jeremy M Grimshaw, Robert J Brison, Brian H Rowe, Jacques S Lee, Amit Shah, Jamie Brehaut, Brian R Holroyd, Michael J Schull, R Douglas McKnight, Mary A Eisenhauer, Jonathan Dreyer, Eric Letovsky, Tim Rutledge, Iain Macphail, Scott Ross, Jeffrey J Perry, Urbain Ip, Howard Lesiuk, Carol Bennett, George A Wells
Affiliations
Randomized Controlled Trial

A prospective cluster-randomized trial to implement the Canadian CT Head Rule in emergency departments

Ian G Stiell et al. CMAJ. .

Abstract

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).

PubMed Disclaimer

Figures

Figure 1
Figure 1
The Canadian CT Head Rule, as used in the study. Note: CSF = cerebrospinal fluid, CT = computed tomography, GCS = Glasgow Coma Scale.
See this image and copyright information in PMC

References

    1. Pitts SR, Niska RW, Xu J, et al. National Hospital Ambulatory Medical Care Survey: 2006 emergency department summary. Natl Health Stat Report. 2008 Aug 6;:1–38. - PubMed
    1. Seelig JM, Becker DP, Miller JD, et al. Traumatic acute subdural hematoma: major mortality reduction in comatose patients treated within four hours. N Engl J Med. 1981;304:1511–8. - PubMed
    1. Marshall LF, Toole BM, Bowers SA The National Traumatic Coma Data Bank. Part 2: Patients who talk and deteriorate: implications for treatment. J Neurosurg. 1983;59:285–8. - PubMed
    1. McCaig LF. National Hospital Ambulatory Medical Care Survey: 1992 emergency department summary. Adv Data. 1994;245:1–12. - PubMed
    1. Stiell IG, Wells GA, Vandemheen K, et al. Variation in ED use of computed tomography for patients with minor head injury. Ann Emerg Med. 1997;30:14–22. - PubMed

Publication types

Associated data