Can We Perform Fewer Head CTs in the Emergency Department?

The Centers for Medicare and Medicaid Services recently issued a utilization measure for cranial computed tomography (CT) scanning for nontrauma indications in the emergency department (ED), but the measure has met with strong criticism (JW Emerg Med Sep 21 2012).

To derive a decision rule for emergent head CT, researchers in Hamilton, Ontario, Canada, retrospectively examined records of 4000 adults who were scanned for nontrauma indications at three hospital EDs during 3 years. Patients with previously known intracranial pathology were excluded. An abnormality was defined as hemorrhage, acute or subacute infarction, mass lesion, or other findings that required intervention or follow-up.

In a 2000-patient derivation cohort, the prevalence of …