Rationale and Objectives
Recent decades have seen a steady increase in noncontrast head CT utilization in the
emergency department with a concurrent rise in the practice of physician assistants
(PAs) and nurse practitioners (NPs). The goal of this study was to identify ordering
and patient characteristics predictive of positive noncontrast head CTs in the ED.
We hypothesized NP/PAs would have lower positivity rates compared to physicians, suggestive
of relative overutilization.
Materials and Methods
We retrospectively identified ED patients who underwent noncontrast head CTs at a
single institution: a nonlevel 1 trauma center, during a 7-year period, recording
examination positivity, ordering provider training/experience, and multiple additional
ordering/patient attributes. Exam positivity was defined as any intracranial abnormality
necessitating a change in acute management, such as acute hemorrhage, hydrocephalus,
herniation, or worsening prior findings.
Results
6624 patients met inclusion criteria. 4.6% (280/6107) of physician exams were positive
while 3.7% (19/517) of NP/PA exams were positive; however, differences were not significant.
Increasing provider experience was not associated with positivity. Attributes with
increased positivity were patient age (p < 0.001), daytime exam (p < 0.05), and indications regarding malignancy (p < 0.001) or focal neurologic deficit (p = 0.001). Attributes with decreased positivity were indications of trauma (p < 0.001) or vertigo/dizziness (p < 0.05).
Conclusion
We found no significant difference in rates of exam positivity between physicians
and NP/PAs, even accounting for years of experience. This suggests increasing utilization
of head CTs in the ED is not due to the increasing presence of NP/PAs, and may be
reflective of general practice trends and clear diagnostic algorithms leading to head
CT.
Key Words
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Article info
Publication history
Published online: May 30, 2022
Accepted:
May 2,
2022
Received in revised form:
April 26,
2022
Received:
January 19,
2022
Identification
Copyright
© 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
