Changing Utilization Patterns of Cervical Spine Imaging in the Emergency Department: Perspectives From Two Decades of National Medicare Claims

Purpose: The aim of this study was to assess the changing use of emergency department (ED) cervical spine imaging in the Medicare population. Methods: Using national aggregate Medicare claims data from 1994 through 2012, all cervical spine radiographic, CT, and MR examinations performed in the ED setting were identified. Shifts in modalities and providers and changes in utilization rates were studied. Results: Between 1994 and 2004, ED cervical spine radiography volumes in the Medicare fee-for-service population increased from 203,645 to 306,442 (+50.5%) and then declined to 152,755 (-50.2%) by 2012. CT volumes increased every year, overall by +8,864% from 1994 through 2012 (from 6,360 to 570,121). MR grew by +1,381%, but volumes overall were small (from 944 to 13,979). With these changes, Cl overtook radiography as the dominant ED cervical spine imaging modality in 2007. Per 1,000 Medicare beneficiaries, utilization rates of radiography, CT, and MR changed by -27%, +8,682%, and +1,351% from 1994 through 2012 (from 6.3 to 4.6, from 0.2 to 17.3, and from 0.0 to 0.4). For all years, compared with other specialists, radiologists remained by far the dominant providers of radiography, CT, and MR (+91.7%, +93.4%, and +96.0% in 1994 and +96.9%, +99.3%, and +99.0% in 2012) in the ED setting. Conclusions: Between 1994 and 2012, the overall utilization rate of cervical spine imaging for Medicare beneficiaries in the ED setting more than tripled. With a small decline in radiography (-27%) but a dramatic increase in CT (+8,864%), CT is now by far the dominant modality for imaging the cervical spine in the ED. Radiologists remain overwhelmingly the dominant providers of these interpretive services.