Neuroimaging utilization in the emergency department has swelled “substantially” over recent years, with increases in head and neck CT angiography the heaviest contributors, according to data released Wednesday.
ED visits have outpaced population growth in the U.S., and providers’ use of advanced imaging for these encounters has followed closely behind. At the same time, overimaging may lead to a number of downstream consequences, including radiation exposure, more incidental findings, and costs incurred by patients and providers, a team of experts out of Georgia explained in AJR.
Wanting to better understand these trends, the group analyzed millions of patient-level claims spanning 2007-2017. Neuroimaging use rates per 1,000 ED visits ballooned by 72% over that time period, with head CTA increasing by 1,100% and neck CTA jumping 1,300%.
The researchers could only speculate as to what may be driving this uptick.
“One of the contributing factors to this growth might be the lack of consensus regarding the optimal use of CT head in EDs, resulting in high variation of ED imaging practice patterns,” Danny R. Hughes, PhD, with Emory University School of Medicine’s Department of Radiology and Imaging Sciences, and co-authors added. “For instance, 10% to 35% of CT orders in the ED for mild traumatic brain injury were shown not to be in accordance with evidence-based guidelines.”
The findings are based on Optum’s De-identified Clinoformatics Data Mart database, which annually includes 12-14 million commercial and Medicare Advantage beneficiaries.
Over the 10-year study period, neuroimaging use grew by nearly 5% each year. Head CT utilization increased by 69%, while head MRI jumped by 67%, head MRA 36%, and neck MRI 52%.
Per 1,000 ED visits, head CT and CTA for head and neck indications increased by 48% in patients 65 and older, the authors reported. Combined with growing usage rates in those with high comorbidity scores, the team suggested older and sicker populations may be partially driving CT increases.
Hughes and colleagues also pegged physician behavioral changes related to pre-authorization outside the ED as possible drivers of CTA and MRI rates. More incidentally detected lesions are also a possible factor.
“Further investigations regarding the appropriateness of neurovascular imaging and ED imaging utilization overall may be helpful to determine if this continued growth in ED imaging volume and intensity-per-patient-encounter are improving health outcomes,” Hughes and colleagues concluded.
Read the full analysis here (behind paywall).
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.