Overimaging and the “Found Down” Patient: An Opportunity to Set the Standard of Care

Abstract

I recently read a head CT study that turned out to be the 100th head CT study performed on a specific patient at our institution in the past decade. Although this sounds extreme, those of us who work in the emergency setting have unfortunately periodically come across this kind of patient: someone whose regular daily routine involves drinking to the point of unconsciousness, stumbling outside, being “found down,” by the police or other good Samaritans, and being brought to the emergency department (ED). The ED physicians understandably cannot obtain a useful history or perform a meaningful neurologic examination because the patient is heavily intoxicated, and they cannot definitively exclude some occult intracranial injury, so they order a head CT, which typically shows the chronic changes of habitual heavy alcohol use, maybe some small-vessel ischemic changes, but nothing acutely treatable. The radiologists thereafter softly scold their ED colleagues in the impression of the report, noting the extreme number of repeat imaging studies for this individual, and suggest that the ED use “risk stratification” for future imaging given the cumulative risk of radiation. And the pattern repeats. Arbitrary Radiation Dose “Limits” Must Not Set Standard of CareJournal of the American College of RadiologyVol. 15Issue 3PreviewIn his recent opinion piece, “Overimaging and the ‘Found Down’ Patient: An Opportunity to Set the Standard of Care,” Dr Mezrich poses the question, “When is a head CT scan one too many?” [1]. He specifically discusses patients who are brought to the emergency department after being found unresponsive (often due to drug or alcohol use), but the topic is applicable to any discussion of patients who receive multiple imaging examinations. Full-Text PDF