CT on the rocks: Alcohol-related injuries tied to higher imaging use, costs
For trauma patients, higher blood alcohol concentration (BAC) was associated with greater use of CT imaging, according to a study published in the October issue of the American Journal of Roentgenology.

Specifically, utilization of head and cervical CT was associated with alcohol-related injuries, and use of abdomen, pelvis and thoracic CT was moderately associated, particularly in patients with less severe injuries, according to Bahman Roudsari, MD, MPH, PhD, of the University of Washington in Seattle, and colleagues.

“In estimation of the economic burden of alcohol-related injuries, only the influence of alcohol on the incidence of injuries is taken into consideration,” wrote the authors. “Often, researchers ignore the potential differences in the average cost of care between alcohol-related and non–alcohol-related injuries.”

To assess the association between BAC and imaging utilization rates, the researchers linked the trauma registry of Harborview Medical Center in Seattle from 2005 to 2009 with billing department data. Patient demographic information and injury-related characteristics were extracted and analyzed.

Results showed that during the study period, a total of 125,776 CT and 4,681 MRI exams were performed on 27,274 patients. Compared with patients who had a BAC of 0, patients with a BAC of 240 mg/dL had higher CT utilization rates, with incidence rate ratios for head CT, cervical spine CT and maxillofacial CT of 1.43, 1.45 and 1.66, respectively.

For head CT, abdomen CT and thorax CT, the association was even more prominent in patients with less severe injuries, according to the authors. They attributed this to the notion that severely injured patients will undergo imaging regardless of BAC, while less severely injured, but alcohol-impaired, patients can be harder to clinically evaluate.

“For mildly injured patients, a good history and physical examination could potentially minimize the need for initial or follow-up imaging,” wrote Roudsari et al. “However, this information is neither reliable nor accurate in a patient under the influence of alcohol.”

No increase in utilization was evident for MRI, according to the results.

The authors suggested that any guideline that could prevent imaging for patient with alcohol-involved injuries could provide cost savings for level 1 trauma centers. “Strategies such as alcohol tax policy have been able to decrease inappropriate alcohol consumption mainly by decreasing accessibility to these beverages for more cost-sensitive consumers,” they wrote. “Similar policies might be adopted to recover some of the extra burden of alcohol-related injuries on our stressed health care system.” Roudsari and colleagues said policy makers could also take measures to make the alcohol industry more accountable.