Number of Head CT Scans Ordered in the ED Vary Widely

The use of head CT scans in the emergency department varies widely depending on who the attending doctors are when patients arrive, according to a study to be published in the April 2012 issue of the American Journal of Medicine.

Researchers from the Brigham and Women’s Hospital in Boston, Mass., looked at 55,281 adult visits to an ED to determine if a head CT scan was performed. The researchers were looking at patient and physician characteristics. Patient data included age, gender, severity of emergency, ED location, and disease category. Physician data included gender and the number of practicing.

Results showed that 8.9 percent of the patient visits involved a head CT scan, with a per-physician ordering ranging from 4.4 percent to 16.9 percent. Those who were most likely to undergo scanning were those who presented with head trauma, stroke, headache, or other type of trauma. Men were also more likely to undergo scanning than were women.

No correlation was found among the physicians’ characteristics as to whether they ordered a scan. No connection was found either regarding time of day of the visit or the location.

“The variability may have been due to physician’s practice style, knowledge gaps, risk tolerance, or other factors,” said lead study author Luciano Prevedello, MD, MPH, of the BWH Center for Evidence-Based Imaging and Department of Radiology.

As facilities work on streamlining their test processes in order to provide better care and reduce costs, these studies are important, experts said. “Attempts to reduce utilization of expensive imaging studies have been made in the past without any real focus on quality of care and appropriate ordering patterns,” said Robert G. Stern, MD, of the Department of Radiology at the University of Arizona College of Medicine, Tucson. “Prevedello and his colleagues underscore the need to develop evidence-based systems to reduce costly and inappropriate resources.”