News & Views: Study: Blood test could provide alternative to CT to diagnose brain injury
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Study: Blood test could provide alternative to CT to diagnose brain injury

Emergency department physicians may turn to a blood test, rather than a CT scan, to diagnose patients with suspected traumatic brain injury (TBI) after researchers discovered an increased blood level of a certain protein in such patients, according to a preliminary study published online in the Annals of Emergency Medicine.

Patients with traumatic brain injuries were shown to have significantly higher levels of glial fibrillary acidic protein (GFAP) than patients without such injuries, marking a promising step in the development of a blood test that could reduce the number of CT scans administered to the 1.4 million people treated annually for traumatic brain injury in U.S. emergency departments.

"This test has the potential for determining injury severity soon after injury, helping emergency physicians make decisions about performing CT scans, seeking neurological consultations and transferring patients to other facilities," said Linda Papa, MDCM, MSc, of the department of emergency medicine at Orlando Regional Medical Center in Florida. "We can perform blood tests now for heart attack, and hope to be able to do the same for traumatic brain injury."

Papa said the GFAP blood test has greater specificity than other blood tests studied for their predictive value in traumatic brain injury, but said it won't totally replace imaging.

"It is not a substitute for all CT scans, but it could possibly rule out patients who do not need them, as well as ensure that patients at risk get CT scans they need," said Papa.

The researchers said further study is necessary before recommending clinical application of a GFAP blood test.

Radiology: Rads rarely guilty of generating high-cost follow-up orders

Radiologists' recommendations for follow-up imaging generated 5.3 percent of chest and abdominal CT, brain and lumbar spine MRI and body PET exams, with pulmonary nodule evaluation identified as the most common cause for follow-up imaging, according to a study published online Nov. 15 in Radiology.

The researchers identified 29,232 high-cost imaging exams and calculated that 5.3 percent were based on a radiologist's recommendation within the previous 60 days. Chest CT accounted for 9.4 percent of radiologists' follow-up recommendations and was prompted by a chest x-ray finding nearly half of the time.

Pulmonary nodules spurred 35.9 percent of the follow-up recommendations, a finding in concordance with the National Lung Screening Trial and adherence to Fleischner Society guidelines for treatment of small pulmonary nodules.

Other common findings leading to follow-up recommendations included pulmonary parenchymal abnormalities other than nodules or masses, adenopathy and renal lesions.

The researchers noted that radiologists struggle with management of adenopathy and renal lesions, which lack criterion to distinguish benign from malignant findings. A recently published American College of Radiology white paper that provides evidence-based guidelines for managing commonly encountered incidental abdominal findings might influence radiologists' recommendations, according to the authors.

Analysis: Medicare imaging spending trends down, not up

An analysis of Medicare data released by the Medical Imaging and Technology Alliance (MITA) found that Medicare spending on medical imaging continues to decline and that Medicare patients are receiving fewer imaging procedures.

The report shows that spending on imaging services for each Medicare beneficiary has dropped 13.2 percent since 2006 when imaging-specific reimbursement cuts from the Deficit Reduction Act began to be implemented. Imaging utilization per beneficiary declined by 3 percent in 2010.

Spending for non-imaging Medicare services has grown by 20 percent since 2006, and utilization increased 2 percent in 2010, according to MITA. Imaging is now a smaller portion of Medicare spending than it was at the turn of the century, MITA said.