COMPUTED-TOMOGRAPHY OF THE HEAD BY THE ACCIDENT AND EMERGENCY DEPARTMENT - WHY 24-HOUR ACCESS IS VITAL

Objective-To examine the use made of 24 hour access to computed tomogr aphy from an accident and emergency (A&E) department and to assess whe ther clear benefits for patients could be identified by having such a service. Methods-Retrospective review of 176 cases where computed tomo graphy was ordered by A&E staff of a large teaching hospital over a on e year period. Results-53% of scans were done ''out of hours''; 97% of scans performed (171/176) were studies of the brain. Three examinatio ns were of the cervical spine and two were of the chest. 54% of head s cans (93/171) were performed for either confirmed or suspected trauma with 46% (78/171) done for medical indications. Only 16% (11/71) of pa tients who had a head scan for acute trauma required transfer to the r egional neurosurgical unit after consultation. Computed tomography was 100% sensitive in the diagnosis of subarachnoid haemorrhage. In cases where computed tomography was performed for coma of undetermined orig in the pathology causing coma was identified on computed tomography in 50% of cases. Conclusions-Computed tomography facilities allow compre hensive initial evaluation of the head injured patient and minimise ha zardous and expensive transfer of these seriously ill patients. Experi ence shows that it is a vital tool in the initial differential diagnos is of the comatose patient and therefore must be available for use by senior and middle grade A&E staff on a 24 hour basis.