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Background <p>Dizziness is a common emergency department (ED) chief complaint, and CT is increasingly used for imaging evaluation. However, the magnitude and implications of this growth remain poorly characterized. We analyzed nationwide trends in ED imaging for dizziness over a 10-year period to quantify CTA utilization patterns and assess their implications for neuroradiology practice.</p> Materials and methods <p>Using the Epic Cosmos database, we identified ED encounters for dizziness, defined by chief complaint or primary diagnosis code R42, among patients of all ages in the United States from 2016–2025. Imaging examinations included CTA head, CTA neck, noncontrast CT head, MRI head, MRA head, and MRA neck performed during the index ED visit. Annual volumes, year-over-year growth rates, utilization rates per 1,000 ED encounters, and growth ratios were calculated and stratified by age group and U.S. Census region.</p> Results <p>From 2016 to 2025, ED encounters for dizziness increased 241% (5,853 to 19,941), whereas CTA head increased 1,860% (160 to 3,136) and CTA neck increased 1,919% (154 to 3,110), corresponding to growth rates 7.7-fold and 8.0-fold higher than ED encounter growth. Mean annual CTA growth rates (40.8%–41.2%) consistently exceeded ED growth (15.3%). CTA utilization increased nearly sixfold, from 27.3 to 157.3 studies per 1,000 encounters, with 15.7% of patients undergoing CTA by 2025. Disproportionate growth was observed across all adult age groups and U.S. regions. In contrast, growth in noncontrast CT (305%), MRI (393%), MRA head (82%), and MRA neck (94%) was proportional to or lower than ED encounter growth.</p> Conclusions <p>CTA utilization for ED dizziness increased approximately 7.7–8.0 times faster than ED encounter growth, representing a fundamental shift in imaging practice across all adult age groups and geographic regions. These findings highlight opportunities for evidence-based optimization of imaging utilization for dizziness in emergency settings.</p> Graphical abstract <p></p>

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National trends in CT angiography use for dizziness in U.S. emergency departments: an Epic Cosmos analysis, 2016–2025

  • 期刊论文

  • 发表日期：

    2026年4月29日

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  • Dhairya A Lakhani,
  • David M Yousem

摘要

Background

Dizziness is a common emergency department (ED) chief complaint, and CT is increasingly used for imaging evaluation. However, the magnitude and implications of this growth remain poorly characterized. We analyzed nationwide trends in ED imaging for dizziness over a 10-year period to quantify CTA utilization patterns and assess their implications for neuroradiology practice.

Materials and methods

Using the Epic Cosmos database, we identified ED encounters for dizziness, defined by chief complaint or primary diagnosis code R42, among patients of all ages in the United States from 2016–2025. Imaging examinations included CTA head, CTA neck, noncontrast CT head, MRI head, MRA head, and MRA neck performed during the index ED visit. Annual volumes, year-over-year growth rates, utilization rates per 1,000 ED encounters, and growth ratios were calculated and stratified by age group and U.S. Census region.

Results

From 2016 to 2025, ED encounters for dizziness increased 241% (5,853 to 19,941), whereas CTA head increased 1,860% (160 to 3,136) and CTA neck increased 1,919% (154 to 3,110), corresponding to growth rates 7.7-fold and 8.0-fold higher than ED encounter growth. Mean annual CTA growth rates (40.8%–41.2%) consistently exceeded ED growth (15.3%). CTA utilization increased nearly sixfold, from 27.3 to 157.3 studies per 1,000 encounters, with 15.7% of patients undergoing CTA by 2025. Disproportionate growth was observed across all adult age groups and U.S. regions. In contrast, growth in noncontrast CT (305%), MRI (393%), MRA head (82%), and MRA neck (94%) was proportional to or lower than ED encounter growth.

Conclusions

CTA utilization for ED dizziness increased approximately 7.7–8.0 times faster than ED encounter growth, representing a fundamental shift in imaging practice across all adult age groups and geographic regions. These findings highlight opportunities for evidence-based optimization of imaging utilization for dizziness in emergency settings.

Graphical abstract