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Scenarios to improve CT head utilization in the emergency department delineated by critical results reporting

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Abstract

Purpose

Increasing use of advanced imaging in the emergency department (ED) has resulted in higher cost without better outcomes. Our goal was to evaluate the yield of CT head exams by scenario to guide efforts at improving patient selection.

Methods

We performed a retrospective study at an academic medical center over 4 years (1/1/2014–12/31/2017). The chief complaint, imaging order, and exam result text were obtained for all adult ED encounters. For the 50 most common chief complaints leading to CT head exams, the ratio of exams to total encounters and ratio of critical results to imaging studies were calculated. Significant difference in “yield” was assessed via binomial test.

Results

Over 708,145 adult ED encounters, 58,783 CT head exams were ordered, with an overall critical result yield of 8.0%. The three most common chief complaints had higher yield (p < 0.05): altered mental status (9.8%), fall (9.7%), and new headache (10.1%). Lower yield (p < 0.05) was found for 19 chief complaints: dizziness (6.2%), falls in patients > 65 years old (7.1%), syncope (5.3%), seizure with known epilepsy (4.8%), chest pain (3.7%), head injury (4.9%), headache re-evaluation (7.0%), alcohol intoxication (2.5%), fatigue (6.5%), headache—recurrent or in the setting of known migraines (5.2%), hypertension (4.4%), lethargy (5.8%), loss of consciousness (5.3%), migraine (3.2%), psychiatric evaluation (2.9%), near syncope (4.6%), drug problem (3.1%), symptomatically decreased blood sugar (3.2%), and suicidal (1.7%).

Conclusion

Our study provides a priority list of low yield scenarios of CT head use for improvement of patient selection.

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Authors and Affiliations

  1. Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA

    Long H. Tu, Ajay Malhotra & Howard P. Forman

  2. Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA

    Arjun K. Venkatesh & Richard A. Taylor

  3. Department of Neurology, Yale School of Medicine, New Haven, CT, USA

    Kevin N. Sheth

  4. Health Policy and Management, Yale School of Public Health, New Haven, CT, USA

    Reza Yaesoubi

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  1. Long H. Tu
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  2. Arjun K. Venkatesh
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  6. Howard P. Forman
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  7. Reza Yaesoubi
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Correspondence to Long H. Tu.

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Approved by the institutional IRB (ID: 2000026885). Waived, per above.

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The authors declare that they have no conflict of interest.

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Tu, L.H., Venkatesh, A.K., Malhotra, A. et al. Scenarios to improve CT head utilization in the emergency department delineated by critical results reporting. Emerg Radiol 29, 81–88 (2022). https://doi.org/10.1007/s10140-021-01947-w

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  • DOI: https://doi.org/10.1007/s10140-021-01947-w

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