Nearly every physician who has worked in an emergency department will concur with the fact that MRI or CT scans are often ordered without being medically necessary and instead, are often ordered because of fear of malpractice lawsuits. In fact, a recent study in Academic Emergency Medicine by Kanzaria, et al. found that 97% of physicians surveyed admitted to ordering at least some advanced imaging studies that weren’t medically necessary.
Along with the possibility that a false-positive result may be found and thus lead to further unnecessary and costly workup, there is also a risk of unnecessary radiation exposure from computed tomography scans. Patients are often not aware of the potential risks of the workup they think they need to have and physicians may order such examinations because of the unfortunate fear of litigation. While we have volumes of evidence-based approaches to nearly every presenting complaint in an emergency room or primary care office, it can be difficult at times to reference such studies as part of the clinical decision support during a patient’s workup. The medical tools exist to help physicians navigate such scenarios.
A 14-month old is brought to a local emergency department after falling onto the floor while climbing on the couch. The parents saw their son hit his head. There was no loss of consciousness and he cried immediately, but was consolable by the time they arrived at the ER. This scenario occurs hundreds of thousands of times per year in the United States. Along with the history and physical examination comes the major question for the emergency room provider, whether or not to order a head CT-scan for this child. To assist the physician, the medicalalgorithms.com app has amongst its 20,000+ algorithms, the criteria for performing a CT scan in a child after head trauma. This can assist in preventing unnecessary imaging and reduce overall healthcare costs.
A few examples of algorithms for use in the emergency department as medical tools for clinical decision support:
Headache:
Alarm Signs and Symptoms in Headache Indicating Possible Serious Intracranial or Systemic Pathology
Scores for Evaluating Adolescent or Adult w/ Mild Head Injury
Abdominal Pain in Males:
Decision Rule of Orient et al for Men with Abdominal Pain (Modified Decision Rule of Wasson et al)
The use of algorithms are not meant to replace physician interaction with patients, but rather enhance the relationship and help to promote evidence-based medicine to help physicians care for their patients. Improving on the estimated $200 billion wasted on unnecessary tests each year by incorporating decision tools into everyday practice is an easy way to improve care and reduce costs.
