July 17, 2013
ER Patient Costs Soaring With Unnecessary CT Scans
Brett Smith for redOrbit.com - Your Universe Online
A new report from researchers at Johns Hopkins has found a significant increase in the use of CT scans on emergency room patients who report severe dizziness to determine if they are suffering a stroke -- to the tune of $3.9 billion in 2011.
The report authors add that a simple bedside test could be used check for stroke, eliminating the need for unnecessary CT scans.
"A lot of resources are expended trying to diagnose dizzy patients, mostly to rule out stroke or other dangerous disorders," said co-author Dr. David E. Newman-Toker, an associate professor of neurology at the Johns Hopkins University School of Medicine and co-author of the study that appeared in Academic Emergency Medicine. "What our study shows is that we need to realign our resources so that we image only the patients who need it, not the ones who don't."
"We need our emergency physicians to be able to confidently identify patients with benign ear conditions who can be safely treated and sent home, without imaging. Accurately and efficiently separating inner-ear patients from the other dizzy patients who probably have strokes will save lives and money," Newman-Toker added.
To differentiate stroke from a more benign inner-ear condition that causes similar symptoms, specialists could use three eye movement tests that have been shown to be fairly accurate - "nearly perfect, and even better than MRI in the first two days after symptoms begin," Newman-Toker noted.
One test, the horizontal head impulse test, is said to be the best predictor of stroke. To perform it, the specialist instructs a patient to look at a target on the wall and keep their eyes fixed as the specialist moves the patient's heads from side to side. A properly trained tester can determine if a patient is making the fast corrective eye movements that signal the more benign condition.
A recently developed small, portable device makes it even easier to detect the subtle telltale eye movements. The machine is made of a set of goggles, a USB-connected webcam and an accelerometer that all work in concert to pick out the eye movements. In a study released earlier this year, strokes were distinguished from inner-ear conditions by the device with 100 percent accuracy.
Newman-Toker said more doctors need to be trained in the procedure, but eventually fewer patients will undergo CT scans, which are expensive and expose the patient to high levels of radiation.
"This is not a problem without a solution," he said. "Experts can do this now, and the ability to transfer that expert knowledge to the front lines of health care is a realistic possibility in the next couple of years."
"These are high-stakes judgment calls that emergency physicians make every day, to send someone home or to order expensive and potentially risky imaging," Newman-Toker continued. "They're still uncomfortable about making the wrong decision and the fear of causing harm or getting sued plays no small part. We want to help doctors make better decisions for patients, while providing the best value for the money."