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Variations in the intensive use of head CT for elderly patients with hemorrhagic stroke

Kimon Bekelis1, Elliott S Fisher, Nicos Labropoulos

  • 1From the Section of Neurosurgery (K.B.) and Department of Medicine (E.S.F.), Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03755; Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (E.S.F., W.Z., J.S.); Geisel School of Medicine (E.S.F.) and Department of Economics (J.S.), Dartmouth College, Hanover, NH; and Department of Radiology, Stony Brook University Medical Center, Stony Brook, NY (N.L.).

Radiology
|October 30, 2014
PubMed

Insights

High head computed tomography (CT) scan use in hemorrhagic stroke patients is common but not linked to better survival. More doctors consulted correlated with increased CT scans, indicating potential overuse.

Area of Science:

  • Neurology
  • Radiology
  • Health Services Research

Background:

  • Hemorrhagic stroke is a critical condition requiring timely diagnosis and management.
  • Computed tomography (CT) of the head is a key imaging modality for stroke patients.
  • Variability in healthcare practices can impact patient outcomes and resource utilization.

Purpose of the Study:

  • To analyze the variation in head CT scan frequency among U.S. hospitals for hemorrhagic stroke patients.
  • To determine the association between head CT scan intensity and patient mortality.
  • To investigate the relationship between the number of consulting physicians and head CT scan utilization.

Main Methods:

  • Retrospective analysis of Medicare fee-for-service claims data (2008-2010).
  • Inclusion of elderly patients admitted for hemorrhagic stroke with 1-year follow-up.
  • Risk-adjusted assessment of mean head CT scans and high-intensity use (≥6 scans).
  • Examination of correlations between high-intensity CT use, physician consultations, and mortality.

Main Results:

  • 53,272 patients with hemorrhagic stroke were analyzed (mean age 79.6 years).
  • Mean head CT scans post-admission was 3.4; 16.4% had ≥6 scans.
  • High-intensity CT use varied significantly across hospitals (8.0%–48.1%).
  • A positive correlation (r=0.522, P<.01) was found between physician consultations and high-intensity CT use.
  • No significant improvement in 1-year mortality was observed for patients with ≥6 head CT scans (OR 0.84).

Conclusions:

  • High rates of head CT utilization in hemorrhagic stroke are prevalent but not associated with reduced mortality.
  • Increased consultation by multiple physicians is linked to higher head CT scan frequency.
  • Findings suggest potential for optimizing head CT imaging protocols in hemorrhagic stroke care.
Abstract

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