title: Head CT scan overuse in frequently admitted medical patients.
abstract: BACKGROUND
  Patients frequently admitted to medical services undergo extensive computed tomography (CT) imaging. Some of this imaging may be unnecessary, and in particular, head CT scans may be over-used in this patient population. We describe the frequency of abnormal head CT scans in patients with multiple medical hospitalizations.
  
  
  METHODS
  We retrospectively reviewed all CT scans done in 130 patients with 7 or more admissions to medical services between January 1 and December 31, 2011 within an integrated health care system. We calculated the number of CT scans, anatomic site of imaging, and source of ordering (emergency department, inpatient floor). We scored all head CT scans on a 0-4 scale based on the severity of radiographic findings. Higher scores signified more clinically important findings.
  
  
  RESULTS
  There were 795 CT scans performed in total, with a mean of 6.7 (± SD 5.8) CT scans per patient. Abdominal/pelvis (39%), chest (30%), and head (22%) CT scans were the most frequently obtained. The mean number of head CT scans performed was 2.9 (SD ± 4.2). Inpatient floors were the major site of CT scan ordering (53.7%). Of 172 head CT scans, only 4% had clinically significant findings (scores of 3 or 4).
  
  
  CONCLUSIONS
  Patients with frequent medical admissions are medically complex and undergo multiple CT scans in a year. The vast majority of head CT scans lack clinically significant findings and should be ordered less frequently. Interdisciplinary measures should be advocated by hospitalists, emergency departments, and radiologists to decrease unnecessary imaging in this population.
authors: Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa. Electronic address: owliam@upmc.edu.
authors: Mina
authors: M
authors: Owlia
authors: Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pa.
authors: Lan
authors: L
authors: Yu
authors: Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa.
authors: Christopher
authors: C
authors: Deible
authors: Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa.
authors: Marion A
authors: MA
authors: Hughes
authors: Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa.
authors: Franziska
authors: F
authors: Jovin
authors: Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa.
authors: Gregory M
authors: GM
authors: Bump
mesh_terms: D000328:Adult; D000368:Aged; D019033:Delivery of Health Care, Integrated / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006257:Head / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D010414:Pennsylvania / Q000453:epidemiology; D011237:Predictive Value of Tests; D011860:Radiography, Abdominal / Q000706:statistics & numerical data; D013902:Radiography, Thoracic / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000592:standards* / Q000706:statistics & numerical data*; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*
keywords: CT scans; Over-utilization; Radiation safety