Impact of the COVID-19 pandemic on emergency CT head utilization in Ontario—an observational study of tertiary academic hospitals

PURPOSE: To determine the impact of the Coronavirus disease-2019 (COVID-19) pandemic on the volume, indications, and results of CT heads performed in the emergency department (ED) at Canadian tertiary academic centers in Ontario. METHODS: A retrospective review of consecutive CT head examinations ordered through the ED during the early stages of the COVID-19 pandemic in Canada (March 12–April 8, 2020) was performed and compared with that during the pre-COVID-19 period (February 12–March 10, 2020). CT reports were reviewed for the exam indication and the presence of predefined acute findings. A two-sample t test was utilized to compare the cohorts. Daily averages were calculated for all measures to control for the sample size difference between each period. A p value < 0.05 was considered significant. RESULTS: Of the total 751 CT head reports, 290 (38.6%) were ordered during the pandemic and 461 (61.4%) were ordered pre-pandemic. The average daily volume of CT head orders decreased significantly during COVID-19 compared with that during pre-COVID-19 (10.4 scans/day vs 16.5 scans/day; p = 0.001). In terms of indications, the frequency of “non-traumatic ICH” was significantly lower during COVID-19 compared with that during pre-COVID-19 (p = 0.01). Also, there was a significant increase in acute findings on CT during COVID-19 compared with that during pre-COVID-19 (p = 0.001). CONCLUSION: The decreased volume of emergency CT heads performed during the COVID-19 pandemic was associated with a significant increase in the proportion of cases with acute findings. This could be a result of the pandemic’s influence on the health-seeking behavior of patients as well as the decision-making process of ordering clinicians.