CT widely used as rule-out test for vets prior to PTSD diagnosis

Presence of posttraumatic stress disorder (PTSD) in young veterans increases odds of CT utilization more than 2.5 times, according to a study published in the May issue of Radiology.

“Because of the costs associated with CT scans and other diagnostic imaging, ensuring that such procedures are used prudently provides an opportunity for the [Veterans Health Administration] to deliver more value-based care,” wrote Thad E. Abrams, MD, MS, of the VA Office of Rural Health, Veterans Rural Health Resource Center-Central Region in Iowa City, Iowa, and colleagues.

“These findings not only highlight the higher utilization of CT scans in patients with PTSD but demonstrate that much of the higher utilization can be attributed to [traumatic brain injury (TBI)], other mental health conditions, pain, and specific types of acute and chronic conditions.”

Results were based on a retrospective study of a national sample of new veteran enrollees, ages 18 to 35 years. A total of 76,812 were included in the full cohort, and the authors examined associations between presence of PTSD and CT, as well as associations with comorbid medical conditions.

Abrams and colleagues reported that 13 percent of the study population received at least one CT scan. PTSD was identified in 21.1 percent of the cohort, and 22.9 percent of those with PTSD received at least one scan, compared with 10.4 percent of those without PTSD.

TBI, abdominal pains and headaches were comorbid factors that could explain the relationship between CT scans and PTSD, according to the authors. The results also showed strong associations with emergency room and primary care utilization.

Daily probabilities of receiving a CT scan were seven times higher prior to the recognition of PTSD, which likely meant CT scans were ordered in a rule-out capacity, speculated Abrams and colleagues.

The authors wrote that identifying patterns of illness could improve the quality of image delivery and practice in general. “For example, we found that the presence of gastrointestinal pain and headaches was strongly associated with both PTSD and the use of CT scans. Thus, the presence of such symptoms in a returning veteran should raise the clinical suspicion for PTSD or the possibility that such symptoms may be somatic in nature in patients with known PTSD.”