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Abrams T. Repeated Computerized Tomography Imaging Among Young Veterans With and Without PTSD. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2011 May 5; Phoenix, AZ.
Background: The Veterans Health Administration (VA) has been faced with a substantial increase in the number of patients with post traumatic stress disorder (PTSD) as a result of the conflicts in Iraq and Afghanistan. As an invisible wound of war, PTSD may complicate the management of other conditions and impact utilization of healthcare resources. We completed this study to examine the influence of PTSD on the receipt of one specific high intensity resource, computerized tomography (CT), in veterans less than 35 years of age. Methods: We performed a retrospective cohort study of 131, 373 new veteran enrollees aged less than 35 years with at least one outpatient visit in 2006. PTSD was identified by specific ICD-9 CM diagnosis codes in a prior outpatient encounter. The use of CT scans during the subsequent three years (2007 - 2009) was identified using common procedural terminology codes '70160 - 75635.' CT scans were categorized into four anatomical areas: brain, head/neck, chest/abdomen/pelvis, and spine. Overall rates of CT imaging and rates of repeat CT imaging (i.e., repeat CT scan in the same anatomical category within 180 days) were compared among veterans with and without PTSD. Generalized linear mixed models were then used to adjust the receipt of CT scans using fixed effects for demographics and comorbid conditions and random intercepts to account for hospital-level variation. Results: PTSD was identified in 15.3% (20,125) of patients and 7.0% (9,220) received at least one CT scan between 2007 and 2009. Veterans with PTSD had substantially higher rates of CT scans relative to those without PTSD (18.1% vs. 5.0; P < .001). Anatomical categories with the highest differences between those with and without PTSD were the brain (9 vs. 2%; P < .001) and chest/abdomen/pelvis (7 vs. 2%; < .001). Repeat imaging was also substantially higher among those with existing PTSD relative to those without (1.5 vs. 0.4%; < .001). In multivariate analyses for the receipt of any repeat imaging, there was a strong association with a diagnosis of PTSD (OR, 2.97; 95% CI, 2.5 - 3.49[P < .001]. In multivariate analyses among the individual anatomical categories for repeat imaging, there were strong associations seen between PTSD and the anatomical areas of the brain, (OR, 2.74; 1.89 - 4.03[P < .001] and spine (OR, 3.22; 1.67 - 6.23 [P < .001]). Notably, CT examinations linked to an emergency room visit accounted for 28% (n = 2,562) of all CT exams. Conclusion: These findings indicate that both PTSD and TBI strongly influence the receipt of costly and resource intense CT examinations. More importantly as young patients, these veterans are likely to have the highest potential risk for the associated consequences of repeated radiation exposure.
