Unnecessary head computed tomography scans: a level 1 trauma teaching experience.

The Canadian CT Head Rule attempts to standardize the practice of obtaining head computed tomography (CT) scans in patients with minor head injury. Previous research indicates 10 to 35 per cent of CT scans performed do not meet these guidelines. The purpose of this study was to review our use of CT scans in the evaluation of mild traumatic brain injury and to identify 1) unnecessary head CT scans (UHCT); 2) variables associated with UHCT; and 3) associated costs. Using a trauma registry, inclusion criteria were age older than 18 years, Glasgow Coma Scale of 15, and at least one head CT scan. UHCTs were those without head injury, loss of consciousness, amnesia, or neurologic complaint. The proportion of patients meeting the criteria for UHCT was 24.2 per cent. Univariate analyses revealed ages 41 to 64 years, drug use, vehicular injury, and surgery within 24 hours were associated with UHCT (all P < 0.05). UHCTs were associated with higher Injury Severity Scores (P = 0.008), ventilator days, and length of stay (all P < 0.05). An average cost of $1,413 per CT equals $149,778 in extra costs. This study suggests that current practices at our Level I trauma center result in UHCT. Further investigation into best practices would benefit our center by reducing costs and providing quality patient care.

Quality of life and mood in older patients after major lung resection.

BACKGROUND: The increasing percentage of older patients undergoing lung resection for cancer necessitates a better understanding of long-term outcomes in this population. We studied the associations among quality of life, mood, clinical factors, and age after major lung resection. METHODS: Outcomes for quality of life and mood questionnaires were compared with clinical factors for older (> or = 70 years) and younger (< 70 years) patients who recovered from major lung resection for stage I or II lung cancer from 1996 to 2006 and were without evidence of recurrence. RESULTS: Of 221 eligible patients, 124 completed questionnaires; 55 (44%) were older (age 76 +/- 4 years). The time from resection was 2.6 +/- 1.6 years. Despite similar comorbidities, older patients were more likely to experience pulmonary (11% versus 3%; p = 0.14), cardiovascular (9% versus 1%; p = 0.087), or any complications (25% versus 12%; p = 0.045). Quality of life function, mood, and symptom scores were similar between the two groups except older patients experienced worse physical function (p = 0.067), fatigue (p = 0.068), and dyspnea (p = 0.094). Postoperative pulmonary complications were related to physical function and dyspnea scores. Covariates for worst quartile scores were percent predicted forced expiratory volume in the first second (physical function, role function, fatigue, pain, and dyspnea) and pulmonary complications (physical function). CONCLUSIONS: Quality of life after recovery from lung resection is similar for older and younger patients despite an increased frequency of postoperative complications among older patients. Important quality of life and symptom score differences are related to percent predicted forced expiratory volume in the first second. This information may help with patient selection and preoperative counseling.