In 2012, the American College of Emergency Physicians (ACEP), like other specialty societies, began a conversation with its members to develop five “Choosing Wisely®” recommendations. One of their first recommendations was to avoid low-value Computed Tomography (CT) scans of the head in patients with minor head injury. ACEP’s multistep process began with input from its Cost-Effective Task Force (Task Force), which administered a survey to ACEP members asking for strategies to “reduce costs and improve value in Emergency Medicine.” The Task Force determined that the evidence was clear; patients with minor head injury that are low risk for intracranial bleeding or skull fracture by decision rules would benefit from a conversation with their clinician on the utility of a head CT.1
For most mild head injured patients that seek care at the Emergency Department a head CT is the traditional assessment tool used. While this makes sense as providers want to rule out the likelihood of the most serious diagnosis (intracranial hemorrhage), which in over 90% of patients scanned will be negative. A single head CT delivers the equivalent radiation as 20 chest X-rays, increasing an individual’s lifetime risk of cancer.