Exploring Senior Emergency Physicians' Perspectives on the Inclusion of Clinical Biomarkers in Clinical Decision Rules for CT Head Use in Patients With Suspected Traumatic Brain Injury

Background

Clinical biomarkers are an objective test with the potential to improve CT head decision pathways by better risk stratifying patients and supporting Emergency department (ED) physician gestalt. Understanding variations in diagnostic approach, risk tolerance and the perceived need to upgrade guidelines and where will help inform further development of novel TBI pathways.

Objectives

This study explored senior emergency physician perspectives regarding current clinical pathways and the potential use of clinical biomarkers as a rule-out test for intracranial pathology in head-injured patients.

Method

This descriptive qualitative design study uses data from 11 individual senior ED clinician interviews. Thematic analysis was then performed.

Results

The three main themes identified were safe practice and clinical decision-making, resources and logistics and challenges of changing practice. While most clinicians reported easy access to CT head scans, most also reported that waiting for CTs was associated with delays. The majority believed that at least some patient groups were over-investigated in this context. Potential benefits of a rule-out biomarker were viewed positively. However, risk tolerance for missed findings was low, ranging from 0.2% to 1%–2%. A strong evidence base demonstrating a biomarker performed with this precision was viewed by most as essential prior to its use.

Conclusion

Senior ED physicians viewed the potential inclusion of biomarkers in CT head guidelines favorably, particularly concerning decision support in low-risk head injuries. However, the lack of expert consensus or strong evidence demonstrating high diagnostic precision in comparable emergency care models limits their introduction.