Immediate computed tomography or admission for observation after mild head injury: cost comparison in randomised controlled trial

Abstract

Objective To compare the costs of immediate computed tomography during triage for admission with those of observation in hospital in patients with mild head injury. Design Prospective cost effectiveness analysis within a multicentre, pragmatic randomised trial. Setting 39 acute hospitals in Sweden Participants 2602 patients (aged ≥ 6) with mild head injury. Interventions Immediate computed tomography or admission for observation. Main outcome measures Direct and indirect costs related to the mild head injury during the acute and three month follow-up period. Results Outcome after three months was similar for both strategies (non-significantly in favour of computed tomography). For the acute stage and complications, the cost was 461 euros (£314, $582) per patient in the computed tomography group and 677 euros (£462, $854) in the observation group; an average of 32% less in the computed tomography group (216 euros, 95% confidence interval −272 to −164; P < 0.001). Sensitivity analysis showed that computed tomography was the most cost effective strategy under a broad range of assumptions. After three months, total costs were 718 euros and 914 euros per patient—that is, 196 euros less in the computed tomography group (- 281 to - 114; P < 0.001). The lower cost of the computed tomography strategy at the acute stage thus remained unchanged during follow-up. Conclusion Patients with mild head injury attending an emergency department can be managed more cost effectively with computed tomography rather than admission for observation in hospital. Trial registration ISRCTN81464462 [controlled-trials.com].