Increasing utilization of emergency department neuroimaging in Medicare beneficiaries from 1994 to 2015

Prabhakar, Anand M.; Gottumukkala, Ravi V.; Hemingway, Jennifer; Hughes, Danny R.; Patel, Sumir; Duszak, Richard

doi:10.1016/j.ajem.2017.12.057

Cited by 41 publications

(15 citation statements)

References 11 publications

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“…Our goals for this study were 2-fold: trying to ascertain the rate of injury in this population, and identifying whether the Canadian CT Head Rule could safely obviate obtaining a CT in this group and therefore decrease CT use in what is considered to be a very low-risk group. There is a steady increase in the use of CT imaging, 5 and this study suggests that providers should have a higher threshold for ordering a head CT in this population. We regret that we did not more carefully define what shared decisionmaking meant in our study.…”

Section: In Replymentioning

confidence: 75%

In reply:

Quaas¹,

Saul²,

Wassermann³

et al. 2019

Annals of Emergency Medicine

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Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist.The content of the submitted letter is solely the responsibility of the authors and does not reflect the official views of any aforementioned establishments.

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Section: In Replymentioning

confidence: 75%

In reply:

Quaas¹,

Saul²,

Wassermann³

et al. 2019

Annals of Emergency Medicine

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“…Despite numerous brain MRI utilization in ED, certainly, imaging alone is not enough, and it is necessary to have a correct interpretation by a physician who has sufficient skills in this regard. So, there is a need for early reports of such imaging via telemedicine or available physicians in the emergency department (ED) (15). Traditionally, radiologists were considered the only qualified physicians in this regard, but quick and easy access to the radiologist is still not possible in most EDs (4).…”

Section: Discussionmentioning

confidence: 99%

Accuracy of Brain MRI Interpretation of Emergency Medicine Specialists Versus Radiologist and Neurologist in Suspected Acute Ischemic Stroke Patients; a Diagnostic Accuracy Study

et al. 2021

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Background: Despite numerous brain magnetic resonance imaging (MRI) utilization in the emergency department (ED), certainly, imaging alone is not enough, and it is necessary to have a correct interpretation by a physician who has sufficient skills in this regard. Objectives: Here, we decided to investigate the accuracy of interpreting brain MRI of suspected acute ischemic stroke (AIS) patients conducted by emergency medicine physicians (EMPs) in comparison with a radiologist and a neurologist. Methods: This diagnostic accuracy study was conducted from April to November 2019 in Tehran, Iran. All attending EMPs of one major educational, medical center, a radiologist, and a neurologist also participated. A set of brain MRI stereotypes related to patients suspected of having a AIS was randomly selected. By reviewing the brain MRI interpretation of EMPs, once in comparison with the radiologist and once in comparison with the neurologist, misinterpretations (presence or absence of findings compatible with the diagnosis of AIS) were extracted. Results: Brain MRI stereotypes of 287 suspected AIS patients were interpreted of these patients, 160 cases (55.7%) were male. The mean age of the study patients was 65.0 ± 14.1 (range of 18 to 98) years. The value of the agreement for diagnosis between EMPs and neurologists was 0.684 (95% CI: 0.580 to 0.787). Considering the neurologist as the gold standard, the accuracy of AIS diagnosis by the EMPs was 0.85% (95% CI: 79.3 to 89.6). The agreement value for diagnosis between EMPs and radiologist was 0.673 (95% CI: 0.553 to 0.794). Considering the radiologist as the gold standard, the accuracy of AIS diagnosis by the EMPs was 86.3% (95% CI: 79.8 to 91.3). The agreement value for diagnosis in these two groups was 0.752 (95% CI: 0.627 to 0.877). Conclusions: The findings of the current study revealed that the accuracy of brain MRI interpretation performed by the EMPs, compared with both neurologist and radiologist was proper.

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“…3,[11][12][13][14][15][16] However, studies demonstrate inconsistent adherence to the guidelines in imaging ordering practices for headache. [17][18][19] In the last two decades, overall imaging utilization, regardless of indication, has been on the rise in the United States, 20 including both the adult and pediatric ED settings [21][22][23][24] with up to 30.0% of currently performed medical imaging of dubious clinical necessity. 23,25,26 The scope and focus of prior studies investigating the use of imaging in headache were limited to outpatient settings, 1,27 ED settings before 2007, 23,28 single-institution cohorts, 6 short (1 year) study periods, 6,29 and single imaging modality, 29 or were based on patient-generated data obtained through household surveys.…”

Section: Introductionmentioning

confidence: 99%

Increasing and disparate use of neuroimaging for adults and children with non‐traumatic headaches in the US emergency departments: Opportunities for improvement

et al. 2020

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Background: Optimization of neuroimaging practices for headache is considered a national priority; however, nationwide patterns and predictors of neuroimaging use for headache in the US emergency departments (EDs) are unknown. Objective: To analyze temporal neuroimaging utilization trends for adults and children with non-traumatic headache in the US EDs and identify factors predictive of neuroimaging use in this patient population. Methods: Retrospective cross-sectional study using the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample database for administrative encounter-level data analysis of a nationwide group of adult and pediatric patients with primary diagnosis of headache (ICD-9CM codes 784.0x, 339.xx, 346. xx) visited the US EDs between January 1, 2006 and December 31, 2014. Temporal trends and independent predictors of neuroimaging use (e.g., patient and hospital characteristics, primary payment sources) were determined. Results: In 2006-2014, a weighted group of 18,146,302 patients with a primary diagnosis of non-traumatic headache visited US EDs. Advanced neuroimaging utilization increased from 18.6% (n = 350,777) to 34.8% (n = 756,895) in the total group, from 18.8% (n = 314,646) to 36.5% (n = 698,080) in the adult subgroup (+94.1%), and from 16.9% (n = 36,131) to 22.0% (n = 58,815) (+30.2%) in the pediatric subgroup (+87.0%) between 2006 and 2014. The strongest predictors of higher neuroimaging utilization were hospital location in the Northeast (OR 3.17, 95% CI 2.67-3.76) or South (OR 2.42, 95% CI 2.03-2.88) regions. Lower utilization of imaging was associated with weekend ED visits (OR 0.92, 95% CI 0.92-0.93), female gender (OR 0.82, 95% CI 0.81-0.83), and Medicare, Medicaid, or self-pay (vs. private insurance) encounters. Conclusion: Neuroimaging utilization in patients with headache in US EDs nearly doubled in 2006-2014, and was used in 34.8% of all ED encounters in 2014. Utilization was higher and increased at faster rates for adults than children. In US EDs, imaging for headache is preferentially performed on commercially insured and male patients, How to cite this article: Trofimova AV, Duszak R, Kadom N, Sadigh G. Increasing and disparate use of neuroimaging for adults and children with non-traumatic headaches in the US emergency departments: Opportunities for improvement.

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Increasing utilization of emergency department neuroimaging in Medicare beneficiaries from 1994 to 2015

Cited by 41 publications

References 11 publications

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In reply:

Accuracy of Brain MRI Interpretation of Emergency Medicine Specialists Versus Radiologist and Neurologist in Suspected Acute Ischemic Stroke Patients; a Diagnostic Accuracy Study

Increasing and disparate use of neuroimaging for adults and children with non‐traumatic headaches in the US emergency departments: Opportunities for improvement

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