Emergency head CT use has more than doubled over last decade
The use of head CT scans in emergency departments has skyrocketed in recent years, more than doubling over the last 15, according to a new analysis published in Neurology.
Approximately 1 out of every 10 patients presenting to the ED will complete a head CT during their visit, according to the study's findings. In 2022, this figure equated to over 16 million scans—more than double the 7.8 million ordered in 2007.
Although these exams are vital for ruling out serious neurological concerns, experts worry the ease of access might be leading to overuse.
“Head CT is an essential element of emergency department diagnosis and treatment of numerous neurologic emergencies,” lead researcher Layne Dylla, MD, PhD, an assistant professor of emergency medicine with the Yale School of Medicine, New Haven, Connecticut, and colleagues noted. “However, it is costly in aggregate, exposes patients to ionizing radiation, and can contribute to increased ED delays and length of stay.”
The team retrospectively analyzed data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) database to identify patterns in CT use across EDs throughout the U.S. Focusing on a 15-year timeframe from 2007 to 2022, the group examined how patient, provider and hospital characteristics might have affected the rise in CT utilization.
In 2007, approximately 6.7% of ED patients received a CT scan, but by 2022, that figure had increased to 10.3%. Patients 65 and up were over six times more likely to have a head CT ordered compared to their younger peers, after controlling for chief concern.
The team also found that black patients were 10% less likely to have the exam ordered during their visit compared to their white counterparts; individuals with Medicaid insurance were 18% less likely to complete the scan compared to those with Medicare or private insurance, while it was ordered 18% less frequently on patients seen at rural hospitals compared to those in urban areas.
Considering the significant growth in head CT utilization over the years, the group advised that future studies on the subject should analyze the exam’s yield in ED settings.
“Overall, these results highlight the need for more equitable access to neuroimaging in emergency care and further evaluation of the appropriateness of every head CT according to clinical recommendations,” the authors suggested.
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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.