A recent study involving nearly 1,000 patients who had head and neck computed tomography angiography (CTA) exams after presenting to the emergency department (ED) with non-focal neurologic complaints found that 75 percent of the cases had negative findings, and 7 percent of patients had unrelated findings. The retrospective study, published in the Journal of the American College of Radiology, reviewed data from head and neck CTA exams performed for 960 patients who presented to the ED for non-focal neurologic complaints. The study found that 5.5 percent of cases had acute or emergent findings related to the presenting complaint, 12.5 percent had non-acute or non-emergent findings related to the complaint, 7 percent had findings unrelated to the complaint, and 75 percent had no actionable findings. The study authors also found that 67 percent of the CTA exams were ordered by non-physician practitioners (NPPs), such as nurse practitioners or physician assistants.
Three key takeaways from the study are:
- There is a high incidence of unnecessary imaging in head and neck CT angiography exams. Over 80 percent of the exams had no actionable findings, suggesting overutilization of imaging and potential unnecessary costs and radiation exposure.
- NPPs are ordering a significant portion of the imaging. 67 percent of the CTA exams were ordered by NPPs, highlighting the need for improved education and guidelines for appropriate imaging utilization.
- There is variability in ordering practices based on the experience and training level of the healthcare provider. Experienced ED attendings were less likely to order low-yield imaging compared to NPPs.
The study authors suggest that future efforts should focus on multidisciplinary education and imaging-ordering support platforms to address these issues and reduce variability in ordering imaging studies.
Sources:
– Journal of the American College of Radiology
– Study co-author Karen Buch, M.D., Associate Professor of Radiology at Harvard Medical School
– Department of Radiology at the Massachusetts General Hospital in Boston
