67% Increase in ED CT Angiogram Ordering for Patients With Headache and Dizziness

There was a 67.4 percent increase in head and neck computed tomography angiography (CTA) ordering for emergency department patients presenting for headache or dizziness from 2017 through 2021, according to a study published online March 21 in Internal and Emergency Medicine.

Grant H. Rigney, from Harvard Medical School in Boston, and colleagues examined trends in head and neck CTA ordering in patients with emergent concerns for nonfocal neurological complaints and determined whether a correlation exists between imaging utilization and positivity rates. The analysis included data from 24,892 patients presenting with headache and/or dizziness to the emergency department of a single quaternary referral center (January 2017 through December 2021).

The researchers found that 9.1 percent of patients underwent head and neck CTA imaging, with an increase in the percentage of patients who received a scan from 7.89 percent in 2017 to 13.24 percent in 2021. This increase represents a 67.4 percent increase from baseline (odds ratio, 1.14). Over time, the positivity rate (the percentage of scans ordered that revealed attributable acute pathology) declined from 16.8 percent in 2017 to 10.4 percent in 2021 (odds ratio, 0.86), a 38 percent reduction in positive examinations.

“This finding suggests the increasing trend does not reflect increasing need, and that hospitals should take steps to ensure that imaging is appropriately used,” co-senior author Marc Succi, M.D., also from Harvard Medical School, said in a statement.

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