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Age- and Region-Stratified Growth in Emergency Department Neuroimaging Utilization within Epic Cosmos, 2016-2025
Pranjal Rai1, Radhika Rajeev2, Ajay Malhotra2
1From the Department of Radiology (P.R.), Mayo Clinic, Rochester, MN; Department of Radiology (R.R.), Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Radiology (A.M.), Yale University, New Haven, CT and Department of Neuroradiology (D.A.L.), Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV. Raipranjal2@gmail.com.
Emergency department (ED) neuroimaging use rose across all ages and US regions from 2016-2025. The increase was most significant in older adults, but consistent across all demographics and geographies.
Area of Science:
- Neuroradiology
- Health Services Research
- Medical Imaging
Background:
- Emergency department (ED) neuroimaging utilization has increased over the past decade.
- Previous studies have not fully characterized if this growth is concentrated in specific age groups or geographic regions.
Purpose of the Study:
- To analyze trends in ED neuroimaging utilization across different age groups and U.S. Census regions.
- To identify demographic and geographic patterns in the increasing use of neuroimaging in emergency departments.
Main Methods:
- Analysis of deidentified aggregate data from Epic Cosmos healthcare organizations (2016-2025).
- Calculation of encounter-adjusted utilization rates for 16 neuroimaging categories per 1,000 ED encounters.
- Stratification by age and U.S. Census region, with temporal trends assessed using Poisson log-linear regression.
Main Results:
- Neuroimaging utilization increased across all age groups and U.S. Census regions between 2016 and 2025.
- The largest absolute increase in utilization was observed in adults aged 65 years or older (+215.1 per 1,000 ED encounters).
- Utilization grew consistently across all regions, with the Northeast showing the largest regional increase (+162.3 per 1,000 ED encounters).
Conclusions:
- ED neuroimaging utilization increased consistently across all evaluated age and geographic strata, not limited to specific groups.
- The magnitude of increase was greater in older adults and varied modestly by region.
- Findings can inform neuroradiology resource allocation, staffing, training, and imaging stewardship initiatives.
