Altered mental status and head CT: Study suggests the exam is overutilized at the expense of patients
A new study published in JAMA highlights the overutilization of head CT scans as a triage tool in instances of acute atraumatic altered mental status (AMS).
The meta-analysis included 25 studies and nearly 80,000 patient cases. Experts found that while 94% of those patients with acute atraumatic AMS underwent non-contrast head CT scans, just 11% of those exams yielded positive results [1].
Corresponding author Roshan Acharya, MD, of Virginia Tech Carilion School of Medicine and co-authors explained that the overuse of head CT in numerous clinical settings, especially when performed in the absence of trauma, is problematic due to the costs it imposes on the healthcare system. Additionally, the exam subjects patients to ionizing radiation exposure that can increase their risks of developing cancer.
“It is estimated that individuals with 3 to 4 lifetime CT studies have similar cancer risks to that of nuclear bombing survivors in Japan, but health care professionals remain unaware of this risk,” the authors wrote.
This is not the first study that has highlighted the overuse of head CT, the authors explained, adding that although their work is among the most extensive on the topic, there are numerous other studies that have resulted in similar findings relative to the exam—high utilization, low yield.
At this point, the question at hand is not whether the scan is used in excess, but why this is the case and how can it be used more effectively?
The authors suggested that the ease of availability is likely among the top reasons head CTs are ordered so frequently. They also indicated that a lack of clear guidelines could be to blame, as could diagnostic dilemmas, defensive medicine and a general lack of awareness pertaining to the hazards of ionizing radiation.
If ordering providers were more aware of the risks associated with radiation exposure, they might be prompted to utilize head CT more judiciously, the authors suggested. They added that awareness campaigns from professional and societal bodies could increase this knowledge and potentially improve overutilization.
The full study is available at JAMA Network Open.
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 joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.