Abstract

High rates of head CT use for patients with hemorrhagic stroke are frequently observed, and while they demonstrate an association with higher number of physicians consulted, they are not associated with mortality.

Purpose

To investigate the variability in head computed tomographic (CT) scanning in patients with hemorrhagic stroke in U.S. hospitals, its association with mortality, and the number of different physicians consulted.

Materials and Methods

The study was approved by the Committee for the Protection of Human Subjects at Dartmouth College. A retrospective analysis of the Medicare fee-for-service claims data was performed for elderly patients admitted for hemorrhagic stroke in 2008–2009, with 1-year follow-up through 2010. Risk-adjusted primary outcome measures were mean number of head CT scans performed and high-intensity use of head CT (six or more head CT scans performed in the year after admission). We examined the association of high-intensity use of head CT with the number of different physicians consulted and mortality.

Results

A total of 53 272 patients (mean age, 79.6 years; 31 377 women [58.9%]) with hemorrhagic stroke were identified in the study period. The mean number of head CT scans conducted in the year after admission for stroke was 3.4; 8737 patients (16.4%) underwent six or more scans. Among the hospitals with the highest case volume (more than 50 patients with hemorrhagic stroke), risk-adjusted rates ranged from 8.0% to 48.1%. The correlation coefficient between number of physicians consulted and rates of high-intensity use of head CT was 0.522 (P < .01) for all hospitals and 0.50 (P < .01) for the highest-volume hospitals. No improvement in 1-year mortality was found for patients undergoing six or more head CT scans (odds ratio, 0.84; 95% confidence interval: 0.69, 1.02).

Conclusion

High rates of head CT use for patients with hemorrhagic stroke are frequently observed, without an association with decreased mortality. A higher number of physicians consulted was associated with high-intensity use of head CT.

Online supplemental material is available for this article.

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Article History

Received June 11, 2014; revision requested July 11; revision received August 18; accepted August 31; final version accepted September 2.
Published online: Oct 29 2014
Published in print: Apr 2015

Vol. 275, No. 1

Supplemental Material

Abbreviations

Abbreviations:
ACO	Accountable Care Organization
CI	confidence interval

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