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ED: Is the cost of CT justified?

por Lauren Dubinsky, Senior Reporter | December 21, 2015
The Aquillion ONE
From the December 2015 issue of HealthCare Business News magazine

Over the past 20 years, the use of CT in the emergency department (ED) has more than tripled, but it’s not clear what effect it has on physicians’ diagnoses. Since CT comes with a high cost and radiation dose, it’s important to know how useful it really is.

“It’s more of an issue of whether the risk-benefit calculus is the right one,” says Dr. Pari Pandharipande, director of the Massachusetts General Hospital Institute of Technology Assessment. “That is a source of ongoing policy dialogue in the health care community regarding CT.” Pandharipande and her fellow researchers decided to investigate what effect CT has on ED physicians’ diagnoses and management decisions. Over the course of 15 months, they assessed CT use at four U.S. academic medical centers.

The ED physicians participating in the study evaluated patients with abdominal pain, chest pain/shortness of breath and headaches, and filled out a survey after their initial evaluation that gauged their confidence in their diagnoses, and another survey after receiving results from the CT exam that asked if their initial diagnosis changed.
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After 245 physicians completed both surveys for 1,280 patients, the researchers found that after CT, the physicians’ initial diagnoses changed for 51 percent of patients with abdominal pain, 42 percent of patients with chest pain/shortness of breath and 24 percent of patients with headache. In addition, CT helped them either confirm or rule out alternative diagnoses 95 to 97 percent of the time for all indications.

“We always want to try to get rid of unnecessary tests — it’s better for people not to have tests that they don’t need,” says Pandharipande. “With this study, we had fairly pronounced results in terms of changes in physician decision-making before and after CT.” Though CT led many physicians to change their diagnoses, that doesn’t preclude the need to constantly get better at trying not to order studies patients don’t need, she adds. The proportion of patients who had diagnoses that changed can either be viewed as a large number or it could be viewed as having a lot of room for improvement, says Pandharipande.

The use of CT in the ED will likely continue to increase because of the unique window it offers into a patient’s health. The risks associated with the technology will also remain, but manufacturers are working to lessen them.

Faster scans and lower dose
In trauma situations, ED physicians must make decisions fast without sacrificing accuracy. Also, health care reform is demanding that they take into account quality and costs more than ever before. Memorial University Medical Center (MUMC) in Savannah, Georgia, has over 95,000 emergency visits and almost 3,000 trauma patients per year. When it had to update its CT systems in 2011, the facility decided to install Toshiba’s Aquilion ONE CT.

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