Abstract TMP37: Regional Changes And Variation In Emergency Department Use Of Neuroimaging During The Mechanical Thrombectomy Era

Abstract

Introduction: Intracranial vascular imaging was rapidly incorporated into acute ischemic stroke guidelines after positive endovascular trials in 2015. Since then, indications for advanced neuroimaging have broadened as the time window for treatment of large vessel occlusion stroke expanded. Although neuroimaging has been added to national guidelines, there may be considerable lag in incorporating these practices into standard ED care based on regional practice. We sought to analyze regional changes and variation in advanced neuroimaging relevant to stroke. Methods: Longitudinal cohort study using adult encounters admitted to the same hospital in the National Emergency Department Sample (NEDS), an AHRQ dataset containing a weighted 20% sample of US ED encounters. Adult encounters from 2013 to 2018 were included in the analysis. CTA and CTP imaging acquired in the ED was determined from Common Procedural Terminology (CPT) codes. Imaging rates per 100k encounters were analyzed by predefined NEDS region (Northeast, Midwest, South, or West) and by year (2013 vs 2018). Descriptive statistics with t-test used for comparison. Results: All regions showed a significant increase in rate of CTA use over time (p<0.001) with the Midwest demonstrating the largest percentage change (542%). All regions showed substantial increases in rate of CTP use across the time period with the Northeast having the largest magnitude of increase (5,376%) followed by the Midwest (1,035%). See Table for detail. Conclusion: Dramatic increases in CTA and CTP use by region were identified both in absolute terms and relative to their use in 2013. The findings demonstrate approximate geographic parity in order of magnitude of use with the change in usage suggesting rapid dissemination of new technologies in stroke imaging and future potential increases. Further analysis will evaluate other hospital properties to better understand changes in imaging rates nationally.