Disparities in use of computed tomography for patients presenting with headache

Headache is a common presenting complaint in the emergency department (ED). Physicians may choose to screen for causes of headache using computed tomography (CT). It is not known whether patient characteristics influence this decision. This study sought to identify patient demographic factors associated with CT evaluation for adult patients with headache.

This study used a retrospective cohort review at an academic, urban ED. Study eligibility was based on chief complaint of headache and final diagnosis of the same. Detailed demographic (age, sex, race/ethnicity, insurance) and clinical (Emergency Severity Index [ESI], Charlson comorbidity score, pain score) data were abstracted from the ED medical record. The main outcome studied was whether a head CT was part of clinical evaluation.

One hundred fifty-five patients were reviewed. Mean age was 42 years (SD, +/-18 years); 75% female, 17% white, 41% black, and 33% Hispanic; 73% were insured; mean ESI was 3.06 (SD, +/-0.64); and Charlson score was 0.60 (SD, +/-1.55). Thirty-seven percent of patients underwent head CT. In multivariable analyses, patients were more likely to undergo head CT if they had greater acuity (ESI < or = 3; odds ratio [OR], 5.11; P < .01) but were less likely to undergo head CT if they were black (OR, 0.21; P < .01) when adjusting for each other as well as older age, sex, comorbidity, insurance status, and history of migraine.

In this study, patients who were black were significantly less likely to undergo head CT during their ED evaluation for headache, independent of clinical and demographic factors.