Increased use of head CT in ED may tantamount to overuse
USA: There was no notable difference in rates of exam positivity between physicians and nurse practitioners (NP)/physician assistants (PAs), even taking into account years of experience, a recent study has found.
The findings, published in Academic Radiology, indicate that the increasing use of head CTs in the emergency department (ED) is not due to the increasing presence of NP/PAs, and may reflect general practice trends and clear diagnostic algorithms leading to head CT.
There has been a steady increase in noncontrast head CT utilization in the ED with a concurrent increase in the practice of PAs and NPs. Considering this, Andrew L. Callen, University of Colorado Anschutz Medical Campus, Aurora, CO, USA, and colleagues aimed to identify ordering and patient characteristics predictive of positive noncontrast head CTs in the ED. They hypothesized that NP/PAs would have lower positivity rates than physicians, suggesting relative overutilization.
For this purpose, the researchers retrospectively identified ED patients who underwent noncontrast head CTs at a single institution, during a 7-year period. They recorded examination positivity, multiple additional ordering/patient attributes, and ordering provider training/experience.
Exam positivity was defined as any intracranial abnormality requiring a change in acute management, such as hydrocephalus, acute hemorrhage, , herniation, or worsening prior findings.
Inclusion criteria were met by 6624 patients.
The study led to the following findings:
- 4.6% (280/6107) of physician exams were positive while 3.7% (19/517) of NP/PA exams were positive; however, differences were not significant.
- Increasing provider experience was not associated with positivity. Attributes with increased positivity were patient age, daytime exam, and indications regarding malignancy or focal neurologic deficit.
- Attributes with decreased positivity were indications of trauma or vertigo/dizziness.
The researchers conclude, "increasing utilization of head CT in the emergency department is not due to the increasing presence of nurse practitioners/physician assistants, and maybe reflective of general practice trends and clear diagnostic algorithms leading to head CT."
Reference:
The study titled, "Ordering Characteristics Predictive of Noncontrast CT Head Positivity in the Emergency Department," was published in the journal Academic Radiology.
