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Yet Another Study Finds CT Overuse In ED

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Once again, a research report says emergency departments overuse CT head scans—this time for patients reporting severe dizziness.

Last month, we reported on a study that found doctors use CT too often to diagnose headaches in children. In January 2012, we mentioned a study determining that CT scans on ED patients experiencing severe dizziness were useful less than 1 percent of the time. And that’s just a sampling.

Now an article in the July issue of Academic Emergency Medicine concludes that half a billion dollars worth of CT scans every year for ED patients with extreme dizziness are unnecessary.

Physicians order such scans to check for stroke. But, the study says, MRI does a much more accurate job of diagnosing stroke, although it costs four times as much as CT. And three eye-movement tests do best of all in distinguishing stroke from more benign causes of dizziness, the study says.

Senior author David E. Newman-Toker, MD, PhD, said fewer than 5 percent of ED patients with extreme dizziness should get CT scans—but:

The trick is figuring out which patients need which imaging tests and which need none at all.

Dr. Newman-Toker is an associate professor of neurology at the Johns Hopkins University School of Medicine in Baltimore. He was quoted in a Hopkins news release distributed via EurekAlert!

The researchers looked at data from the Medical Expenditure Panel Survey and the National Hospital Ambulatory Medical Care Survey. They found that the annual number of ED visits for dizziness increased by 97 percent from 1995 through 2011, from 2 million to 3.9 million. The percentage of those visits that involved advanced imaging grew from 10 percent in 1995 to nearly 40 percent in 2011.

“These are high-stakes judgment calls that emergency physicians make every day, to send someone home or to order expensive and potentially risky imaging,” Dr. Newman-Toker said. “They’re still uncomfortable about making the wrong decision, and the fear of causing harm or getting sued plays no small part. We want to help doctors make better decisions for patients while providing the best value for the money.”

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One Response to “Yet Another Study Finds CT Overuse In ED”

  1. Radiology Daily»AlertArchive » Child Head CT Decision Gets More Complicated on July 24th, 2013 at 5:58 pm

    […] have suggested cutting back on CT scans of children’s heads in cases of dizziness (as we reported last month and in January 2012) and headache (as we reported last month). Studies have warned about an […]