The use of head CT during emergency department (ED) encounters increased more than twofold between 2007 and 2022, according to a study published November 19 in Neurology.
A team led by Layne Dylla, MD, of Yale University School of Medicine in New Haven, CT, found that head CT scan use during the period increased from 7.8 million to 16 million, and noted that “racial, insurance, and geographic variations continue to exist in head CT usage.”
Head CT is a key part of emergency department workup. But it can be costly and contributes to increased ED delays and patients’ length of stay in the hospital — and also exposes patients to radiation.
Dylla and colleagues investigated head CT use in a nationwide sample of EDs between 2007 and 2022 using information from the National Hospital Ambulatory Medical Care Survey (NHAMCS) database. They assessed the odds of an ED encounter including a CT scan of the head, applying NHAMCS survey weights and tracking factors such as the year of the visit, patient demographics (age, sex, race, and ethnicity), and hospital characteristics.
The group’s primary finding was that use of head CT in the ED increased by 6.7% to 10.3% over the study timeframe: In 2007, the number of ED encounters that included a head CT was 7.8 million, and by 2022, it was 15.9 million (p < 0.001).
The investigators did not discover a significant interaction between time (years) and sex, but the interaction between time and age was significant, with a p-value of less than 0.001.
“Patients aged 65 years or older had 6.24 times the odds of receiving a head CT compared with patients aged younger than 18 years after controlling for year, month, and chief concern at ED admission,” they reported.
They also found that Black patients, those on Medicaid, and those presenting at a rural hospital were less likely to undergo head CT (odds ratios, 0.9, 0.82, and 0.76, respectively).
“Given increasing rates of head CT scans in the ED, additional evaluation of their yield in comparison with the relative risks and costs is needed,” the team concluded.
Take a look at the full study here.