Advanced imaging use for mini strokes rises substantially in US emergency departments
Advanced imaging is increasingly being used in cases of transient ischemic attacks in emergency departments, potentially leading to more patients being discharged, rather than monitored as inpatients.
Findings from a new national study highlight changes in care delivery, rising costs and disparities between rural and urban hospitals in such "mini-stroke" cases. Authors of the paper, published in JAMA, noted that the shift toward ED-based evaluation has implications for both healthcare costs and department capacity. Although discharging patients after an expedited evaluation may reduce the need for hospitalization, it can place additional demands on ED workflows and imaging departments.
What’s more, this may be more difficult to implement in settings with limited diagnostic resources.
“For U.S. patients presenting to the emergency department with transient ischemic attack, guidelines recommend resource-intensive multimodal evaluation to optimize secondary stroke prevention,” Lauren E. Mamer, MD, PhD, with the department of emergency medicine at Michigan Medicine, and colleagues noted. The authors added that these resources are not available in all EDs, especially those in rural settings.
The retrospective study analyzed more than 2.1 million ED visits for transient ischemic attacks from 2013 to 2021 using the National Emergency Department Sample, a nationally representative database. Researchers examined trends in discharge practices, imaging use and inflation-adjusted ED costs to identify trends in resource utilization.
Based on their investigation, the research team reported that the adjusted probability of ED discharge increased from 45% in 2013 to 66% in 2021. At the same time, imaging use among discharged patients grew substantially; the predicted probability of computed tomography angiography (CTA) use increased from 4% to 45%, while MRI use rose from 17% to 53%.
Costs also increased during the study period. Average ED charges per encounter climbed from $1,746 in 2013 to $2,755 in 2021, after adjustment for inflation.
Researchers also identified differences by hospital setting. Discharge rates were higher at rural hospitals than at urban facilities throughout the study period, while MRI use was lower in rural encounters. These differences may reflect limitations in access to imaging and other resources needed to support rapid outpatient evaluation.
“This approach has consequences in terms of cost and ED throughput and may not be as feasible in rural hospitals as it is in urban hospitals,” the group noted.
It should be noted that the study was observational and examined national trends rather than whether specific resource utilization improved patient outcomes. As such, the findings do not establish whether increased ED discharge or imaging use led to better secondary stroke prevention.
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In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.