ED Neuroimaging Spikes over Decade

Utilization of head and neck CT angiography (CTA) in the emergency department ballooned, outpacing all other neurological exams.

In a study published Aug. 5 in the American Journal of Roentgenology, a team of investigators from the Georgia Institute of Technology (Georgia Tech) determined that the compound annual growth rate for these scans was 25 percent to 27 percent from 2007 to 2017. Unenhanced head CT was the most common neuroimaging exam in the emergency department, they said.

“The rapid growth of head and neck CTA observed in the fee-for-service Medicare population is also observed in the commercially insured and Medicare Advantage populations,” said Selin Merdan, Ph.D., associate director of the Value Analytics Lab in Georgia Tech’s department of industrial and systems engineering.

For their study, Merdan’s team evaluated the annual emergency department utilization of head CT, head MR, head CTA, neck CTA, head MR angiography (MRA), neck MRA, and carotid duplex ultrasound. They based their assessment on patient-level claims from Optum’s De-identified Clinformatics Data Mart database – a database that includes between 12 million and 14 million commercial and Medicare Advantage health plan enrollees.

They adjusted utilization rates using annual relative proportions of age groups and stratified by patient demographics, payer type, and provider state to account for an older sample population.

Based on their analysis, they determined emergency department neuroimaging use spiked 72 percent overall during the study period. Specifically, they found these increases: 69 percent for head CT, 67 percent for MRI, 1,100 percent for head CTA, 1,300 percent for neck CTA, 36 percent for head MRA, 52 percent for neck MRA. They also identified a slight drop of 8 percent for carotid duplex ultrasound.

Credit: American Journal of Roentgenology

In addition, among patients 65 and older, head CT and CTA of the head and neck experienced a continuous increase of 48 percent and 1,011 percent, respectively, for every 1,000 emergency department visits.

These findings, the team said, warrant paying closer attention to neuroimaging use in the emergency department.

“The appropriateness of this growth should be monitored as the indications for CTA expand and more incidental findings are uncovered,” the team said.

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