title: Variations in the intensive use of head CT for elderly patients with hemorrhagic stroke.
abstract: OBJECTIVE
  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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: From the Section of Neurosurgery (K.B.) and Department of Medicine (E.S.F.), Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03755; Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH (E.S.F., W.Z., J.S.); Geisel School of Medicine (E.S.F.) and Department of Economics (J.S.), Dartmouth College, Hanover, NH; and Department of Radiology, Stony Brook University Medical Center, Stony Brook, NY (N.L.).
authors.forename: Kimon
authors.initials: K
authors.lastname: Bekelis
authors.forename: Elliott S
authors.initials: ES
authors.lastname: Fisher
authors.forename: Nicos
authors.initials: N
authors.lastname: Labropoulos
authors.forename: Weiping
authors.initials: W
authors.lastname: Zhou
authors.forename: Jonathan
authors.initials: J
authors.lastname: Skinner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging* / Q000453:epidemiology; D008297:Male; D006278:Medicare; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging* / Q000453:epidemiology; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology