Effect of continuous professional development and clinical imaging guidelines on reducing inappropriate computerized tomography utilization among children and young patients in low resource settings: a before-and-after study

TL;DR

This study examines how training and guidelines affect CT scan use in Ugandan hospitals, finding mixed results in reducing inappropriate scans among children and young patients.

Contribution

The study evaluates the real-world impact of training and guidelines on CT utilization in low-resource settings, revealing both successes and challenges.

Findings

CT examinations increased by 33% post-intervention, with higher rises in private hospitals.

Inappropriate CT use overall increased by 15%, despite reductions in some categories.

Trauma-related CTs decreased by 8%, but contrasted studies rose sharply by 252%.

Abstract

The overuse of CT examinations (CTEs), especially in low-resource settings (LRS), is a growing public health issue. Up to 50% of these CTEs are considered inappropriate, with children and young adults being particularly affected. While clinical imaging guidelines (CIGs) have been developed to address this issue, their effectiveness in LRS remains unclear.

This study aimed to assess the impact of continuous professional development (CPD) and the introduction of CIGs on CT appropriateness in Ugandan hospitals.

A before-and-after study was conducted in six public and private hospitals over 12 months.

Post-intervention, CTEs performed increased by 33%, with significant rises in public hospitals (30%) and private-for-profit hospitals (41%). Head CTs rose by 19%, and contrasted studies substantially increased by 252%. Conversely, trauma-related CTEs decreased by 8%. However, the overall proportion of inappropriate CTEs increased by 15%, with inappropriate contrasted examinations rising by 28% and non-trauma cases by 13%. Inappropriate non-contrasted CTEs and trauma-related CTEs reduced by 28% and 31%, respectively.

The study highlights the challenges of consistently implementing CIGs in LRS, despite some improvements. It calls for more tailored interventions and further research to explore factors influencing guideline adoption to optimize CT utilization and improve patient outcomes.

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