Variation in Use of Head Computed Tomography by Emergency Physicians - 23/03/12
, Ali S. Raja, MD, MBA, MPH a, c, e, Richard D. Zane, MD a, c, e, Aaron Sodickson, MD, PhD a, b, e, Stuart Lipsitz, ScD d, e, Louise Schneider, MD a, c, Richard Hanson a, b, Srinivasan Mukundan, PhD, MD a, b, e, Ramin Khorasani, MD, MPH a, b, e
Requests for reprints should be addressed to Luciano M. Prevedello, MD, Department of Radiology, Brigham and Women's Hospital, 20 Kent St, Brookline, MA 02445Abstract |
Objective |
Variation in emergency department head computed tomography (CT) use in patients with atraumatic headaches between hospitals is being measured nationwide. However, the magnitude of interphysician variation within a hospital is currently unknown. We hypothesized that there was significant variation in the rates of physician head CT use, both overall and for patients diagnosed with atraumatic headaches.
Methods |
This cross-sectional study was conducted in the emergency department of a large urban academic hospital, and institutional review board approval was obtained. All emergency department visits from 2009 were analyzed, and the primary outcome measure was whether or not head CT was performed. Logistic regression was used to control for patient, physician, and visit characteristics potentially associated with head CT ordering. The degree of interphysician variability was tested, both before and after controlling for these variables.
Results |
Of 55,286 emergency department patient encounters, 4919 (8.9%) involved head CT examinations. Unadjusted head CT ordering rates per physician ranged from 4.4% to 16.9% overall and from 15.2% to 61.7% in patients diagnosed with atraumatic headaches, with both rates varying significantly between physicians. Two-fold variation in head CT ordering overall (6.5%-13.5%) and approximately 3-fold variation in head CT ordering for atraumatic headaches (21.2%-60.1%) persisted even after controlling for pertinent variables.
Conclusion |
Emergency physicians vary significantly in their use of head CT both overall and in patients with atraumatic headaches. Further studies are needed to identify strategies to reduce interphysician variation in head CT use.
Le texte complet de cet article est disponible en PDF.Keywords : Computed tomography, Emergency department, Head, Ordering, Variation
Plan
| Funding: None. |
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| Conflict of Interest: Dr Sodickson is a consultant for Siemens and Toshiba CT. Dr Mukundan is the recipient of corporate-sponsored research grants on advanced visualization of CT scans and advanced magnetic resonance technique development, and a scientific consultant for Marval Biosciences (preclinical contrast agent). None of the other authors have any conflicts of interest associated with the work presented in this manuscript. |
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| Authorship: All authors had access to the data and played a role in writing this manuscript. |
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| Robert G. Stern, MD, Section Editor |
Vol 125 - N° 4
P. 356-364 - avril 2012 Retour au numéro
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