To the Editor.—
Garraway et al1 may be correct that in the isolation of Olmstead County there has been no significant increase in the number of patients worked up for possible subdural hematoma since the introduction of computed tomographic (CT) scanning. However, on the basis of claims submitted for payment of CT head scans for "possible subdural hematoma," it seems quite possible that the data from Olmstead County may be misleading as far as the general community is concerned.At many institutions it seems that CT scans are obtained routinely, for all patients with symptoms of conditions such as dementia, drug overdose, Alzheimer's disease, senility, stroke, and chronic headache. The data that Garraway et al present provide convincing evidence that when case selection is appropriate, as in Olmstead County, introduction of CT scanning results in a reduction in the cost of care for subdural hematoma. However, if one adds
Shapiro MJ. The Influence of CT Scanning on the Cost of Workup for Subdural Hematoma. JAMA. 1986;255(6):747–748. doi:10.1001/jama.1986.03370060061016
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