Difficulties in Requesting CT imaging in Head Injury: Another Role for Ultrasound?

Luke T Iddon, Specialist Registrar,
June 15, 2011
The National Audit Office (1) has evaluated delays when requesting Computed Tomography (CT) scans for patients with head injury and reveals that nationally, a quarter of patients may wait for more than two hours. This work also found, that in London alone the average delay in transfer from local hospital to specialist unit is typically six hours. In the West Midlands Workforce Deanery, a survey of senior (ST4 and above) Emergency Medicine trainees was carried out to discover their experiences of requesting imaging in head injury. A good response rate (87% of 46 trainees) was achieved, with representation from all sixteen training sites in the region. Some 28% of trainees do not have 24/7 access to a CT scan, performed and reported, within an hour. With the imminent arrival of regional Trauma Networks the demand for rapid access to CT will increase in both large Major Trauma Centres and smaller Trauma Units alike. The survey makes it clear that not all EDs are able to access timely diagnostic imaging for their patients.
I have followed with interest Major's (2) work using Transorbital Ultrasound to measure the Optic Nerve Sheath Diameter and evaluate raised intracranial pressure (ICP). Currently there is insufficient evidence to support such a use of ultrasound in the non-traumatic setting but it has potential as a triage tool, to rule in raised intracranial pressure in the context of head injury. A bedside test performed on arrival in a rural Trauma Unit could obviate unnecessary delay in obtaining CT and secondary transfer to a Major Trauma Centre.
1 Major Trauma Care in England, National Audit Office 2010, London
2 Major R., Girling S., Boyle A. Emerg Med J (2010). Doi;10.1136/emj.2009.087353

Conflict of Interest:

None declared

Conflict of Interest

None declared