| A prospective cluster-randomized trial to implement the Canadian CT Head Rule in emergency departments. | |
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MedLine Citation:
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PMID: 20732978 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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). |
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Authors:
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Ian G Stiell; 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 |
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Publication Detail:
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Type: Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't Date: 2010-08-23 |
Journal Detail:
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Title: CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne Volume: 182 ISSN: 1488-2329 ISO Abbreviation: CMAJ Publication Date: 2010 Oct |
Date Detail:
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Created Date: 2010-10-05 Completed Date: 2010-11-01 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9711805 Medline TA: CMAJ Country: Canada |
Other Details:
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Languages: eng Pagination: 1527-32 Citation Subset: AIM; IM |
Affiliation:
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Department of Emergency Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont. istiell@ohri.ca |
| Data Bank Information | |
Bank Name/Acc. No.:
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ClinicalTrials.gov/NCT00993252 |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Aged, 80 and over Canada Cluster Analysis Confidence Intervals Craniocerebral Trauma / radiography* Female Humans Male Middle Aged Practice Guidelines as Topic* Prospective Studies Sensitivity and Specificity Tomography, X-Ray Computed* |
| Grant Support | |
ID/Acronym/Agency:
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MOP-62795//Canadian Institutes of Health Research |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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