Considerable variation in CT use in ischemic stroke

(HealthDay)—For patients with ischemic stroke there is considerable variation in the rates of high-intensity computed tomography (CT) use, according to a study published online April 8 in Circulation: Cardiovascular Quality and Outcomes.

Kimon Bekelis, M.D., from Dartmouth-Hitchcock Medical Center in Lebanon, N.H., and colleagues performed a retrospective analysis of Medicare fee-for-service claims data for 327,521 adults admitted for ischemic stroke to examine use of CT scans. Patients were admitted from 2008 to 2009 and followed for one year.

The researchers found that the average number of head CT scans in the year after admission was 1.94, while 11.9 percent of participants had four or more CT scans. Considerable regional variation was seen in high-intensity CT use, with risk-adjusted rates ranging from 4.6 percent in Napa, Calif., to 20.0 percent in East Long Island, N.Y. Furthermore, rates were 2.6 percent higher for blacks than whites. There was a correlation between higher fragmentation of care (greater number of different doctors seen) with high-intensity CT use; patients living in the top versus the lowest quintile regions of fragmentation had a 5.9 percent increase in the rate of high-intensity CT use (odds ratio, 1.77). Considerable regional variation was seen in one-year risk- and price-adjusted expenditures, from $31,175 in Salem, Mass. to $61,895 in McAllen, Texas. There was a positive association for regional rates of high-intensity CT scans with one-year expenditures (P < 0.01).

"Rates of high-intensity CT use for patients with ischemic stroke reflect wide practice patterns across regions and races," the authors write.

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