Computed tomography in patients with cerebrovascular disease: impact of a new technology on patient care

The medical care of 157 patients with suspected cerebrovascular disease was analyzed to assess the impact of the new technology, computed tomography (CT) of the brain, on the care of these patients. A cohort of patients admitted before installation of CT was compared to two cohorts admitted after installation of CT. Length of hospital stay, speed of diagnostic workup, treatment, and discharge plans were not significantly different. Discharge diagnoses were more specific after installation of CT. Lumbar punctures and radionuclide brain scans were used less frequently, but utilization of other diagnostic studies was unchanged. Aggregate charges for diagnostic procedures actually increased in both after-CT groups. In this study, addition of CT to the neurodiagnostic armamentarium resulted in little demonstrable improvement in the care of these patients with cerebrovascular disease but did increase the cost of evaluation. This is unlike the situation for patients with brain tumors, where CT was shown to improve care while not increasing cost. These results may help guide the use of CT by physicians caring for patients with cerebrovascular disease and suggest that health planners not use all patients with cerebrovascular disease in estimating need for CT.