A study on the increased use of imaging in the emergency department raises questions about how to best provide quality, cost-effective care to patients, and at least one expert sees implications for comparative-effectiveness research and value-based insurance design (VBID).
The use of CT and MRI scans for injury-related ED visits in the United States tripled between 1998 to 2007, but there was no commensurate increase in the prevalence of the diagnosis of certain life-threatening, trauma-related conditions. The research, which used data from the National Hospital Ambulatory Medical Care Survey, appeared in the October 6 issue of JAMA.
The widespread availability of CTs and MRIs and their ability to identify significant injuries "have made these tools important in the evaluation of patients presenting to emergency departments," the authors write. Nevertheless, the increased use of these tools is associated with higher costs, greater exposure to ionizing radiation, and more time spent in the ED.
What drives this increased use? The researchers cite a variety of possible factors, including the superiority of CT scans over x-rays for diagnosing conditions such as cervical spine fractures, availability of CT scanners, and concerns about malpractice lawsuits over a missed diagnosis.
More work is needed to understand these factors: "The role of evidence-adoption strategies such as computerized decision support and audit and feedback in promoting adherence to decision rules for imaging needs to be further understood," the authors conclude.