Patterns of head CT utilization in emergency department patients with minor head injury: a systematic review
Kafle, Satyasuna Dass, Jaipal Shrestha, Roshan Karki, Dipesh Abdulsattar, Saif Imtiaz, Hassan Zahid, Areeba Umer, Muhammad Rizwan Bakka, Havil Stephen Alexander Rafiq, Inam
Kafle, Satyasuna
Dass, Jaipal
Shrestha, Roshan
Karki, Dipesh
Abdulsattar, Saif
Imtiaz, Hassan
Zahid, Areeba
Umer, Muhammad Rizwan
Bakka, Havil Stephen Alexander
Rafiq, Inam
Abstract
Minor head injury (MHI) is a frequent presentation to emergency departments (EDs), and while most patients recover uneventfully, a small proportion develop clinically important traumatic brain injury (ciTBI). Computed tomography (CT) is the diagnostic gold standard for detecting intracranial pathology, but its widespread use contributes to unnecessary radiation exposure, higher costs, and ED crowding. To optimize utilization, several clinical decision rules, including the Canadian CT Head Rule, New Orleans Criteria, National Emergency X-Radiography Utilization Study II (NEXUS-II), and National Institute for Health and Care Excellence (NICE) guidelines, have been developed to balance sensitivity for ciTBI with the need to limit avoidable scans. This systematic review, conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, searched PubMed, Embase, Scopus, and the Cochrane Library up to August 2025. Of the 96 records screened, five studies with over 44,000 patients met the inclusion criteria. The findings indicate that although decision rules demonstrate high sensitivity and strong potential to reduce unnecessary imaging, variability in adherence leads to both overuse and underuse of CT. Greater integration of validated rules into clinical workflows and decision-support systems is needed to enhance patient safety, reduce costs, and improve efficiency in the management of MHI.
MIDER Authors
Affiliations
Barking, Havering and Redbridge University Hospitals NHS Trust; Walsall Healthcare NHS Trust; Northwick Park Hospital; Manchester University NHS Foundation Trust; University Hospitals Dorset NHS Foundation Trust; Faisalabad Medical University; Royal Sussex County Hospital; Dow University of Health Sciences
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Date
2025-10-11
Type
Article
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Citation
Kafle S, Dass J, Shrestha R, Karki D, Abdulsattar S, Imtiaz H, Zahid A, Umer MR, Bakka HSA, Rafiq I. Patterns of Head CT Utilization in Emergency Department Patients With Minor Head Injury: A Systematic Review. Cureus. 2025 Oct 11;17(10):e94370. doi: 10.7759/cureus.94370. PMID: 41230306; PMCID: PMC12603434.