Are Head CT Scans Overutilized in Emergency Departments?

Recently published research demonstrated that annual head computed tomography (CT) scans more than doubled in emergency department (ED) settings from 2007 to 2022.

In an interview with Diagnostic Imaging, lead study author Layne Dylla, M.D., shared her thoughts and concerns about the increasing head CT volume.

“ … We have to really think about lowering the number of CTs we order and perform. In terms of that, there are clinical decision tools that emergency physicians use on a daily basis that kind of tell you from a risk stratification perspective, who is ultra-low risk of having something dangerous and who's a little bit higher risk. The challenge with those tools is that we haven't universally studied them in older populations,” noted Dr. Dylla, an assistant professor in the Department of Emergency Medicine at the Yale University School of Medicine.

The study findings showed that head CTs were obtained in over 10 percent of all ED visits in 2022 and 20.6 percent of these head CTs were ordered for patients > 65 years of age.

“As we have an aging population, we have more people who are kind of in their later years who are having falls. While in a 18-year-old, a fall may not be a big deal, when you get to be a little bit older, those falls have more serious consequences (as they may be) more likely to have head bleeds. With an increasing elderly population, there are increasing indications for CT scans of the head,” added Dr. Dylla.

While Dr. Dylla noted relatively stable head CT volume in ED settings between 2007 and 2022 for children and patients between 18 and 44 years of age, she said the overall doubling of annual head CTs contributes to increased radiation exposure, health-care costs and overcrowding at health-care facilities.

“Patients are going to wait longer to get seen by a physician, because we have more patients who are waiting on their CT scan to be performed and then read by a radiologist,” pointed out Dr. Dylla. “I think there's a lot of things that are potentially negative consequences of this, but again, you have to always be thinking risk and benefit for every single patient, and that's a challenge that we just haven't quite overcome yet.”

(Editor’s note: For related content, see “New Study Shows Doubling of Head CT Scans in Emergency Departments,” “Five-Year Study Shows Significant Overuse of CT Angiography in the ER” and “CT Radiation Exposure and Hematologic Cancers in Children: An Interview with Rebecca Smith-Bindman, MD.”)

For more insights from Dr. Dylla, watch the video below.