Head CT scan overuse in frequently admitted medical patients.
Am J Med. 2014 Feb 5;
Authors: Owlia M, Yu L, Deible C, Hughes MA, Jovin F, Bump GM
BACKGROUND: Patients frequently admitted to medical services undergo extensive Computed Tomography (CT) imaging. Some of this imaging may be unnecessary, and in particular head CTs may be over-used in this patient population. We describe the frequency of abnormal head CTs in patients with multiple medical hospitalizations.
METHODS: We retrospectively reviewed all CT scans done in 130 patients with greater than 7 admissions to medical services between January 1and December 31, 2011 within an integrated health care system. We calculated the number of CT scans, anatomic site of imaging, and source of ordering (emergency department, inpatient floor). We scored all head CTs on a 0-4 scale based on the severity of radiographic findings. Higher scores signified more clinically important findings.
RESULTS: 795 CT scans were performed in total with a mean of 6.7 (±SD 5.8) CT scans per patient. Abdominal/Pelvis (39%), chest (30%), and head (22%) CT scans were the most frequently obtained. The mean number of head CTs performed was 2.9 (SD ±4.2). Inpatient floors were the major site of CT scan ordering (53.7%).Of 172 head CTs, only 4% had clinically significant findings (scores of 3 or 4).
CONCLUSIONS: Patients with frequent medical admissions are medically complex and undergo multiple CTs in a year. The vast majority of head CTs lack clinically significant findings and should be ordered less frequently. Inter-disciplinary measures should be advocated by hospitalists, emergency departments and radiologists to decrease unnecessary imaging in this population.
PMID: 24508413 [PubMed - as supplied by publisher]