Lukasz Babiarz MD, MBA, Presenter: Nothing to Disclose

Stella Liang, Abstract Co-Author: Nothing to Disclose

Paul Intihar MS, Abstract Co-Author: Nothing to Disclose

David M. Yousem MD, Abstract Co-Author: Royalties, Oakstone Publishing, LLC Author with royalties, Reed Elsevier Research Grant, Bayer AG

We set out to assess the changes in neuroimaging utilization and its effect on hospitalization cost of patients admitted with stroke and transient ischemic attack (TIA) between 2004 and 2013 at a major urban academic medical center.

Hospital billing and administrative data were used to identify inpatients discharged with stroke and TIA diagnoses during 2004-2013. Basic demographics, hospital length of stay (HLOS), number of neuro-CT and MR exams performed, case complexity, intensive care unit (ICU) stay, surgical intervention, and neuroimaging, ICU, surgical, and total hospitalization cost were collected. Summary statistics and compound annual growth rates (CAGRs) for cost components were calculated.

3,582 patients (mean age: 62.1 years; 1,818 Female) were admitted with stroke and TIA during 2004-2013. Mean HLOS was 4.62 days (annual range: 4.12-4.95 days). Mean case complexity was 1.004 (annual range: 0.928-1.132). Comparing 2004 to 2013: the proportion of patients having neuro-CTs increased from 84% to 86%; having neuro-MRs from 77% to 91%; and requiring ICU care from 15% to 24%. The average number of CTs and MRs per admission increased from 1.4 to 2.3 and from 1.1 to 2.6, respectively. As a percent of total hospitalization cost, CT grew from 2.0% to 4.7% and MR from 8.2% to 14.9%. During 2004-2013, 3.2% patients required ICU/surgical care, 13.2% ICU care, 4.7% surgical care, and 78.8% required neither. ICU care comprised ~32% of total cost. The number of neuro-scans for ICU/surgical patients grew from 3.1 to 9.1 (CAGR=12.7%), for ICU patients from 3.6 to 5.6 (CAGR=5.1%), for surgical patients from 3.3 to 4.8 (CAGR=4.5%), and for the remaining patients from 2.3 to 4.4 (CAGR=7.2%). The total and non-neuroimaging cost grew at CAGR of 4.5% and 3.0%, respectively.

Neuroimaging utilization for patients admitted for stroke and TIA has increased with a greater percentage of patients being imaged and a greater number of studies being performed per patient. Neuroimaging cost has gone up and it was responsible for 1/3 of all interval hospitalization cost increases. ICU and surgical patients undergo more neuroimaging.

Neuroimaging utilization for patients with stroke and TIA has been increasing. This has contributed to the interval increase in hospitalization cost.

Babiarz, L, Liang, S, Intihar, P, Yousem, D, Neuroimaging Utilization and Hospitalization Cost for Patients Admitted with Stroke and Transient Ischemic Attack.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14015782.html