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Decadal Trends in Emergency Department Head and Neck CTA Utilization: A Comprehensive Analysis of Volume, Trauma, and
Yu Sakai1, Alvand Hassankhani2, Shawn Lyo2
1From the Department of Radiology (Y.S., A.H., S.L., A.V., M.J., A.P., J.D., D.T., D.W., S.M.), Emergency Medicine (G.L.L., L.F.), University of Pennsylvania, Philadelphia, PA, USA. yu.sakai@pennmedicine.upenn.edu.
Background And Purpose:
Neuroradiology services report rising ED CTA head and neck demand. Although late-window thrombectomy trials increased interest in perfusion-based selection, relative growth of CTA head and neck versus CT perfusion (CTP), and how these trends compare with overall neuro-ED imaging volume, ED throughput, and coverage periods, remains incompletely characterized. We evaluated decade-long neuro-ED imaging trends at a tertiary care academic medical center.
Materials And Methods:
Retrospective observational study including all neuroradiology ED examinations from two hospital ED sites from fiscal years (FY) 2016-2025. Primary outcomes included annual CTA head, CTA neck, and CTP volumes; their proportions of total neuro-ED imaging; examinations per ED encounter; and (CTA head + CTA neck)-to-CTP ratio. Encounter-normalized trends for FY2016-FY2025 were modeled using negative binomial regression. Coverage-period distribution was assessed using CTA exam-code rates per hour during regular versus on-call hours. Secondary clinical-context sub-analyses assessed baseline National Institutes of Health Stroke Scale (NIHSS) and large language model (LLM)-assisted report abstraction for indications and large vessel occlusion (LVO) yield.
Results:
Across 303,753 neuro-ED examinations, ED encounters increased modestly from FY2016 to FY2025 (+11%, 108,948 to 121,288), while neuro-ED imaging more than doubled (+111%, 20,087 to 42,398). Combined CTA head and neck examination-code volume increased 8.5-fold (745 in FY2016 to 6,317 in FY2025). Share of CTA head and neck rose from 3.7% (745/20,087) to 14.9% (6,317/42,398) of neuro-ED imaging. Encounter-normalized utilization increased significantly for CTA head and neck (incidence rate ratio [IRR] per FY 1.22 and 1.20, respectively; both p<0.001) but did not change significantly for CTP (IRR 1.00). (CTA head + CTA neck)-to-CTP ratio increased from 4.2 in FY2018 to 9.9 in FY2025. CTA rates per hour increased during both regular and on-call coverage without differential growth. Secondary exploratory analyses suggested increasing CTA use in NIHSS 0 presentations and declining LVO yield.
Conclusions:
Over a decade at a tertiary academic center, ED CTA head and neck volumes rose sharply, outpacing ED throughput, overall neuro-ED imaging growth, and CTP utilization. CTA demand increased similarly across regular and on-call periods, underscoring escalating after-hours operational burden and implications for neuroradiology coverage models.
