Overutilization? CT utilization for falls up 150 percent since 2001

The number of adult patients who underwent CT scans for injuries resulting from falls increased dramatically from 2001-2010, according to a study published in the March issue of the American Journal of Roentgenology

Due to its sensitivity in imaging traumatic injuries, CT has become increasingly popular in emergency departments for doctors assessing trauma patients. Approximately 80 million CT scans are performed annually. More and more of those scans are being performed on patients suffering from injuries sustained in an accidental fall, says Waleed Brinjikji, MD, and his fellow researchers at the Mayo Clinic in Rochester, Minn., “Given the aging of the United States population, fall-related injuries have emerged as a significant epidemiologic problem,” wrote the authors. “Costs associated with hospitalization for fall-related injuries in the elderly are estimated to be over $20 billion per year.”

To find out how CT is being utilized to assess these injuries, the researchers conducted an analysis of all U.S. adult patients presenting to the ED following falls between 2001 and 2010 using the National Ambulatory Medical Care Survey. Trends in CT utilization and the amount of life-threatening injuries sustained in falls were analyzed and compared.

Out of a total of 73,241,368 ED visits resulting from falls during the study timeframe, Brinjikji used 22,166 unweighted observations for the study. CT utilization for falls increased from 11 percent in 2001 to 28 percent in 2010, while the number of patients presenting with injuries from fall only increased from 6 to 8 percent over the same timeframe, resulting in a 2.5-fold increase in CT utilization. “These findings are important because they show that CT is increasingly used among adult ED fall patients and may in fact be overutilized,” wrote Brinjikji and colleagues.

Guidelines meant to improve the diagnostic yield of imaging within EDs, including recently released Appropriateness Criteria from the American College of Radiology, are a good starting point, say Brinjikji et al, but the need for more research remains. “Further work is needed to determine the patient, hospital, and physician factors that are responsible for this significant increase in CT utilization and to optimize CT utilization” the authors wrote. “Additional studies in the field of decision support for fall patients could be a potential means of decreasing CT utilization for fall patients.”