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AJR Am J Roentgenol. 2016 Dec;207(6):W117-W124. Epub 2016 Aug 30.

The Association Between Use of Brain CT for Atraumatic Headache and 30-Day Emergency Department Revisitation.

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1 BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 800 University Bay Dr, Ste 310, Mail Code 9123, Madison, WI 53705.
2 Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN.
3 Department of Emergency Medicine, Northwestern University, Chicago, IL.
4 Department of Biostatistics and Medical Informatics, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI.
5 Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
6 Department of Emergency Medicine and Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT.



The purpose of this article is to describe the association between initial CT for atraumatic headache and repeat emergency department (ED) visitation within 30 days of ED discharge.


A retrospective observational study was performed at an academic urban ED with more than 85,000 annual visits. All adult patients with a chief complaint of headache from January through December 2010 who were discharged after ED evaluation were included in the analysis. Patients were excluded if they were transferred, died in the ED, or had a diagnosis indicating a traumatic mechanism. A propensity score-matched logistic regression model was used to determine whether the use of brain CT was associated with the primary outcome of ED revisitation within 30 days, controlling for potential confounding variables.


Of 80,619 total patient visits to the ED during the study period, 922 ED discharges with a chief complaint of headache were included. A total of 139 (15.1%) patients revisited within 30 days. The return rate was 11.2% among patients who underwent CT at their initial visit and 21.1% among those who did not. In the adjusted analysis, controlling for age, race, sex, insurance status, triage vital signs, laboratory values, and triage pain level, the odds ratio for revisitation given CT performance was 0.49 (95% CI, 0.27-0.86).


After adjustment for clinical factors, we found that patients who underwent a brain CT examination for atraumatic headache at an initial ED visit were less likely to return to the ED within 30 days. Future appropriate use quality metrics regarding ED imaging use may need to incorporate downstream health care use.


CT brain; appropriate use; emergency; headache

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