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Trends in non-focal neurological chief complaints and CT angiography utilization among adults in the emergency department

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Abstract

Prudent imaging use is essential for cost reduction and efficient patient triage. Recent efforts have focused on head and neck CTA in patients with emergent concerns for non-focal neurological complaints, but have failed to demonstrate whether increases in utilization have resulted in better care. The objective of this study was to examine trends in head and neck CTA ordering and determine whether a correlation exists between imaging utilization and positivity rates. This is a single-center retrospective observational study at a quaternary referral center. This study includes patients presenting with headache and/or dizziness to the emergency department between January 2017 and December 2021. Patients who received a head and neck CTA were compared to those who did not. The main outcomes included annual head and neck CTA utilization and positivity rates, defined as the percent of scans with attributable acute pathologies. Among 24,892 emergency department visits, 2264 (9.1%) underwent head and neck CTA imaging. The percentage of patients who received a scan over the study period increased from 7.89% (422/5351) in 2017 to 13.24% (662/5001) in 2021, representing a 67.4% increase from baseline (OR, 1.14; 95% CI 1.11–1.18; P < .001). The positivity rate, or the percentage of scans ordered that revealed attributable acute pathology, dropped from 16.8% (71/422) in 2017 to 10.4% (69/662) in 2021 (OR, 0.86; 95% CI 0.79–0.94; P = .001), a 38% reduction in positive examinations. Throughout the study period, there was a 67.4% increase in head and neck CTA ordering with a concomitant 38.1% decrease in positivity rate.

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Author notes

  1. Grant H. Rigney and Alexander H. King have indicates co-first authorship and equal contribution to this manuscript.

  2. Karen Buch and Marc D. Succi have indicates co-senior authorship.

Authors and Affiliations

  1. Harvard Medical School, Boston, USA

    Grant H. Rigney, Alexander H. King, Janice Chung, Soham Ghoshal, Aditya Jain, Zhuo Shi, Shahaan Razak, Joshua A. Hirsch, Michael H. Lev, Karen Buch & Marc D. Succi

  2. Department of Radiology, Massachusetts General Hospital, Boston, USA

    Joshua A. Hirsch, Michael H. Lev, Karen Buch & Marc D. Succi

  3. Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, USA

    Grant H. Rigney, Alexander H. King, Janice Chung, Soham Ghoshal, Aditya Jain, Zhuo Shi, Shahaan Razak, Joshua A. Hirsch, Michael H. Lev, Karen Buch & Marc D. Succi

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Marc D. Succi, Karen Buch, Grant Rigney, and Alex King. The first draft of the manuscript was written by Grant Rigney, Alex King, Janice Chung, Soham Ghoshal, Aditya Jain, Zhuo Shi, and Shahaan Razak and all authors commented on previous versions and final versions of the manuscript. All authors critically reviewed, read, and approved the final manuscript.

Corresponding author

Correspondence to Marc D. Succi.

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Ethical approval, Human and animal rights statement and Informed consent

This study was supported in part by a grant from the Harvey L. Neiman Health Policy Institute (J.A.H.). The authors have no other relevant financial or non-financial interests to disclose. This research study was conducted retrospectively from data obtained for clinical purposes. We consulted extensively with the IRB of Massachusetts General Hospital who determined that our study did not need ethical approval. An IRB official waiver of ethical approval was granted from the IRB of Massachusetts General Hospital.

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Data for this study are not publicly available; however, requests for data will be considered in line with institutional policy.

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Rigney, G.H., King, A.H., Chung, J. et al. Trends in non-focal neurological chief complaints and CT angiography utilization among adults in the emergency department. Intern Emerg Med (2024). https://doi.org/10.1007/s11739-024-03569-9

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