A new study suggests that head CT could be overused in the emergency department for patients presenting with conditions like headache and dizziness. Writing in a paper in Internal and Emergency Medicine, researchers looking at CT angiography use at a large medical center found a big increase in CTA utilization – even as the rate of positive findings dropped.
CTA is a powerful tool that can quickly and efficiently give clinicians information to guide treatment of acute neurovascular conditions like aneurysm and stroke.
- As such, many emergency departments have been installing their own CT scanners to enable them to scan emergent patients without transporting them to the radiology department.
But with great power comes great responsibility, and there is always the temptation to scan first and ask questions later.
- To better understand changing CTA use in the emergency setting, researchers from the Harvey L. Neiman Health Policy Institute analyzed CTA exams at a level 1 trauma center that sees about 110k emergency patients a year.
Researchers analyzed 25k ED visits from 2017 to 2021 and correlated them to head and neck CTA exams for headache and/or dizziness, finding …
- The rate of CTA exams rose 64%, from 7.9% of ED visits to 13%
- Symptomatic patients were 15% more likely to have a CTA in 2021 versus 2017
- The rate of positive CTA findings fell 38%, from 17% to 10%
- Patients with private insurance were more likely to have CTA (OR=1.44)
- Black patients were less likely to be scanned (OR=0.69)
The researchers said the findings indicate the need for better clinical decision support tools, which they believe can help emergency physicians provide an accurate diagnosis without exposing patients to unnecessary radiation and incurring additional cost.
The Takeaway
This study further confirms widespread accounts that head and neck CTA is overused and on the rise. As the US government backs off on its attempt to force clinical decision support on referring physicians, it may be up to health systems and providers themselves to ensure more appropriate utilization – in a way that doesn’t rely on heavy-handed tools like prior authorization.
