The utility of computed tomography at a district-level public hospital in Cape Town

Abstract

Background: Computed tomography (CT) has become an invaluable aid in medical diagnostic workup, and its global usage has been shown to be consistently increasing across all departments. While typically located in regional or central hospitals in South Africa, its recent introduction at the district level has many foreseeable benefits. We evaluated its utility at one of the first district hospitals in the Western Cape to obtain a CT suite. Objectives: This study aimed to describe the type of CT scans ordered, the clinical indications, the prevalence of significant abnormal findings and the agreement between the clinical opinion and radiological diagnosis. Methods: A descriptive cross-sectional study was conducted over a 1-year period at Khayelitsha Hospital, an entry-level hospital just outside of Cape Town. Results: A total of 3242 CT scans were analysed. The mean age of patients was 46 years; 51.4% were males. A mean of 13 scans were performed per working day. The head and neck area were the most scanned region (n = 1841, 52.3%). Predominantly requested by the Emergency Centre (n = 1382, 42.6%), indications were mainly for general medical conditions workup (n = 2151, 66.4%). Most scans showed abnormalities (n = 2710, 83.6%), with 2115 (65.2%) considered relevant (‘positive yield’). Clinical and CT diagnoses agreed in 1610 (49.7%) cases. Conclusion: Computed tomography usage at the district level demonstrated positive yield rates comparable to that of tertiary centres. This implies an appropriate utilisation of the service with a potential decrease in the burden on the referral centre. Contribution: Computed tomography scanners at district-level facilities are appropriately utilised and can provide greater access to care while potentially decreasing the burden on referral centres.

Keywords

• computed tomography
• emergency medicine
• family medicine
• primary healthcare
• radiology
• district hospital
• yield