Rising analysis continues to counsel overutilization of head and neck computed tomography angiography (HNCTA) in emergency division (ED) settings.
For the retrospective examine, not too long ago revealed in Inside and Emergency Drugs, researchers reviewed HNCTA ordering and positivity charges for sufferers who introduced with headache (HA) and/or dizziness (DZ) to the emergency division of an instructional medical heart over a five-year interval. A complete of two,264 sufferers (out of 24,892 sufferers presenting with HA and/or DZ) underwent HNCTA, in keeping with the examine.
The researchers discovered that 662 sufferers out of 5001 sufferers (13.24 p.c) with HA and/or DZ displays obtained HNCTA exams in 2021 compared to 422 out of 5,351 sufferers (7.89 p.c) in 2017. Along with the 67.4 p.c improve in CTA exams on this inhabitants, the examine authors famous a 38.1 p.c lower in acute pathological findings with CTA exams between 2017 (71 of 422 sufferers, 16.8 p.c) and 2021 (69 of 662 sufferers, 10.4 p.c).
Along with the 67.4 p.c improve between 2017 and 2021 in CTA exams for sufferers with headache and/or dizziness displays within the emergency division, the examine authors famous a 38.1 p.c lower in acute pathological findings with CTA exams between 2017 (71 of 422 sufferers, 16.8 p.c) and 2021 (69 of 662 sufferers, 10.4 p.c).
“Our examine thus contributes to the notion that CT ordering charges within the ED are rising whereas including that this improve could also be pointless, as (evidenced) within the lowering proportion of scans ordered that yielded a discovery of pathology related to the indication for the scan,” wrote examine co-author Marc D. Succi, M.D., a board-certified emergency radiologist and affiliate chair of innovation and commercialization at Massachusetts Basic Hospital in Boston, and colleagues.
Examine findings additionally revealed that sufferers with non-public insurance coverage have been 44 p.c extra more likely to obtain HNCTA exams than sufferers with Medicare. The examine authors additionally discovered that Black sufferers have been 31 p.c much less more likely to have a HNCTA examination than White sufferers.
“Whereas a number of explanations exist to elucidate these outcomes, it’s potential that systemic and implicit biases affect HNCTA ordering charges within the ED,” posited Succi and colleagues.
Three Key Takeaways
- Improve in HNCTA utilization. The examine highlights a notable improve within the utilization of Head and Neck Computed Tomography Angiography (HNCTA) in emergency division (ED) settings, with a 67.4 p.c rise in exams performed over a five-year interval. This development suggests a possible overutilization of HNCTA scans for sufferers presenting with headache (HA) and/or dizziness (DZ) signs.
- Lower in optimistic findings. Regardless of the rise in HNCTA utilization, there was a big lower (38.1 p.c) within the discovery of acute pathological findings related to these scans. This lower in optimistic findings signifies {that a} appreciable portion of HNCTA exams could also be pointless, including weight to the argument of overutilization.
- Disparities in examination distribution. The examine additionally reveals disparities within the distribution of HNCTA exams, with sufferers having non-public insurance coverage being 44 p.c extra more likely to obtain these exams in comparison with these with Medicare. Moreover, Black sufferers have been discovered to be 31 p.c much less more likely to endure HNCTA exams than White sufferers, suggesting potential systemic and implicit biases influencing ordering charges within the ED. Addressing these disparities and biases is essential for making certain equitable healthcare supply.
The examine authors emphasised the dearth of a longtime normal with respect to the positivity fee of HNCTA exams carried out in emergency departments and that medical judgment calls usually come into play. They added that facility-specific practices, medicolegal issues and time constraints are different components which will influence ordering of HNCTA exams.
“Contemplating proof introduced herein, re-evaluation of current frameworks governing HNCTA acquisition is required,” added Succi and colleagues.
(Editor’s notice: For associated content material, see “Examine Reveals Important Overutilization of Head and Neck CT Angiography within the ER,” “Head CT for Acute Stroke Sufferers: Examine Reveals 22 P.c Enchancment for 30-Minute Turnaround Occasions” and “Examine Says MRI Presents Most Value-Efficient Imaging for Dizziness Shows within the ER.”)
Past the inherent limitations of a single-center retrospective examine, the authors conceded potential bias with respect to affected person and end result choice. Additionally they acknowledged that the COVID-19 pandemic, which occurred through the course of the examine, might have affected ordering practices for imaging within the emergency division.
