The portion of patients undergoing unnecessary CT angiography in the ED for a headache or dizziness soared more than 67% over a four-year period while the corresponding positivity rate plummeted.
That’s according to new research out of the Neiman Health Policy Institute, published in Internal and Emergency Medicine [1]. Numerous analyses, along with anecdotal reports, have charted a significant uptick in the use of CTA in recent years. This latest batch of single-center data lend further credence to concerns the increase is unwarranted and requires efforts to better educate referrers.
“There are competing pressures in the ED to make a quick and conclusive diagnosis to increase the turnover of beds. However, missing a diagnosis places patients at risk and exposes the hospital and attending physician to potential litigation and penalty,” Joshua Hirsch, MD, senior affiliate research fellow at the institute, said March 28. “The solution isn’t to restrict access to valuable advanced imaging such as CTA but to provide referring physicians with a frictionless way to evaluate the appropriateness of imaging.”
Scientists conducted the retrospective study at a more than 1,000-bed urban academic medical center with a 66-bed emergency department serving 110,000 individuals annually. They pinpointed all adult ED encounters between 2017 and 2021 with a chief concern of headache or dizziness. Among nearly 25,000 visits during the study period, 9% (or 2,264) of patients underwent head and neck CTA. The percentage of those who received such a scan climbed from nearly 8% (422/5,351) in 2017 up to over 13% by 2021 (662/5,001). That represents a roughly 67.4% jump from the baseline, Hirsch et al. noted.
However, the percentage of scans ordered that revealed noteworthy, related findings drop from 17% (71/422) in 2017 down to 10% (69/662) by the end of the study period. That’s a roughly 38% decrease in positive examinations.
“Unfortunately, our results also revealed potential biases in the use of CTA for certain patient groups,” study co-senior author Karen Buch, MD, a neuroradiologist at Massachusetts General Hospital said in the announcement. “Specifically, patients with private insurance were more likely to have a CTA, whereas the likelihood of a CTA was less for black compared to white patients.”
The study was limited to a single center and did not ascertain whether imaging use was appropriate, the authors cautioned. Read more about the results—and our previous coverage on increasing CTA volumes—at the links below.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.