Emerg Radiol (2007) 13: 189 DOI 10.1007/s10140-006-0533-5

REMARK S ON THE EDITOR’S COMMENT

Charles J. Prestigiacomo

Appropriateness of out-of-hours CT head scans

Published online: 23 November 2006 # Am Soc Emergency Radiol 2006

Ravindran et al. present a very compelling retrospective study evaluating the efficacy, or appropriateness, of “out-ofhours” head computed tomography (CT) in a general district hospital of the United Kingdom. They assessed whether urgent CT scans of the head performed between the hours of 1700 and 0900 were appropriate based on a change in the patients’ management or based on whether the ordering of the scans adhered to stated guidelines. In their study spanning 4 months, 121 patients were studied with 66% of the scans being performed between the hours of 1700 and 2200. In 80% of the patients, there was a change in management or disposition, with only 17% of these changes occurring after 0830 the following day. The authors concluded that a substantial portion of these scans were appropriate and led to a change in the patient’s immediate care. In this study, the authors recognize and begin to address the dissonance that seems to be occurring in the UK with regards to a substantial increase in the number of out-ofhours head CT scans needed to provide excellent patient care and a relatively limited resource, namely trained radiologists that would be available to read these scans during the out-of-hours period. The legitimate and likely

This reply refers to the Editor’s comment (http://dx.doi.org/10.1007/ s10140-006-0532-6). C. J. Prestigiacomo (*) Departments of Neurological Surgery and Radiology, Neurological Institute of New Jersey, UMDNJ–New Jersey Medical School, Newark, NJ 07103-2406, USA e-mail: [email protected] Tel.: +1-973-9722325

factors that may explain the rise in the need for out-ofhours CT and the concomitant growing strain that this puts on the UK’s radiology services are pointed out throughout the manuscript. This study does indeed indicate that the majority of urgent studies ordered (80%) affected the patient’s immediate treatment and disposition. Interestingly, more than half of these studies were performed between 1700 and 2200 hours. Although the authors provide justification for the use of out-of-hours head CT scans in their hospital, it is unclear whether there might be a need for greater latitude in ordering out-of-hours CT scans in the setting of suspected acute cerebral ischemia or subarachnoid hemorrhage. Although lacking in sufficient statistical analyses, this study brings to light the need for a more careful evaluation of the UK’s criteria for ordering out-of-hours head CT that will hopefully result in a resolution in the perceived dissonance between the possible increased need for out-of-hours head CT and the experienced radiologists needed to accurately interpret them. Such studies may be of great benefit in helping other countries develop evidence-based criteria to determine indications for imaging.