Finding balance in emergency CT

Efforts to curb the overutilization of imaging have been a topic of discussion for a number of years, spurred by the growth of imaging in the mid-2000s.

Though this growth curve has leveled off more recently, it’s still a critically important effort to reduce the use of inappropriate imaging. Healthcare costs in the U.S. are high enough without unnecessary resource utilization, and patients suffer the risks of over-testing.

But what can’t be forgotten is the value imaging brings to patient care. Any efforts to cut imaging rates must be highly focused on exams that offer little benefit, while appropriate imaging continues unencumbered.

We got another reminder of this fact in one of this week’s top stories. Published in Radiology, a new study of nearly 1,300 cases found that CT use in the emergency department often led to changes in patient management.

In other words, imaging works.

The study included surveys of 245 physicians from four different academic medical centers. Physicians gave initial diagnoses, along with a confidence rating, before viewing CT results and then again after. Patients were presenting to the ED with a variety of indications, including abdominal pain, chest pain/shortness of breath and headache.

Survey results revealed that the CT scans led to a change in diagnosis in 51 percent of patients with abdominal pain, 42 percent of patients with chest pain/shortness of breath and 24 percent of patients with headache. Moreover, the scans helped confirm or rule out alternative diagnoses in at least 95 percent of cases across all symptom groups.

Of course, CT should not be used indiscriminately, but as lead author Pari Pandharipande, MD, MPH, director of the Massachusetts General Hospital Institute of Technology Assessment, pointed out, efforts to reduce ED CT usage should not compromise patient care.

“Emergency department physicians who face increasing pressure to make clinical decisions quickly are sometimes criticized for ordering too many CT scans that may not be clinically justified,” said Pandharipande in a statement. “We found that – for patients with abdominal pain, chest pain or shortness of breath, or with headache – physicians’ leading diagnoses and management decisions frequently changed after CT and that diagnostic uncertainty felt by physicians was alleviated.”

-Evan Godt
Editorial Director