Patients less likely to return to ER within 30 days if they receive CT on initial visit

A retrospective observational study found that patients who came into the emergency department and received a CT exam in their initial visit were less likely to return for a follow-up within 30 days.

"I think it would be easy to misinterpret this study as a call for increasing the practice of ordering CT scans for atraumatic headache," said study coauthor Brian W. Patterson in a statement. "Our findings do not support such a recommendation. Rather, we are calling attention to the downstream effects of these scans, and suggesting that future attempts to define appropriateness of imaging within the emergency department (ED) will need to account for their potential to lessen future care utilization."

After noticing the trend of criticism for performing CT imaging in emergency departments, the authors grew enough interest to perform the study. The authors wrote that there has been a variety of efforts with objectives to reduce CT use within emergency departments due to their risks associated with ionizing radiation and its costs.

"This conflict creates a need to evaluate the value added by advanced imaging performed during ED visits, and to better understand how imaging use at an initial ED visit influences subsequent resource utilization and outcomes," said Patterson.

Researchers published their findings in the December 2016 issue of the American Journal of Roentgenology in a report called, “The Association Between Use of Brain CT for Atraumatic Headache and 30-Day Emergency Department Revisitation.”

Two possible explanations for their findings performed at Northwestern Memorial Hospital is that CT provided a peace of mind for patients, feeling they did not need to return, or primary care clinicians are more focused and better able to manage the symptoms of acute headache after a CT scan is done. 

According to the data from the study, there were 80,619 patients during the study period, including 922 emergency department discharges with a chief complaint or headache. Some 139 patients came back to the ER within 30 days, with a return rate of 11.2 percent amongst patients who underwent CT at their first visit to the emergency room, whereas 21.1 percent of those who did not.