Background: The November 2013 AAO-HNSF Clinical Practice Guidelines for Bell’s Palsy advise against routine computed tomography (CT) scans and magnetic resonance imaging (MRI) in working up Bell’s Palsy.
LO: Data from Maryland’s State Emergency Department Database (SEDD) suggest that the guidelines decreased CT/MRI utilization in patients with Bell’s Palsy.
SO: Investigate statewide emergency room utilization of imaging in Bell’s Palsy patients before and after the guidelines were published and characterize factors associated with receiving imaging.
Design: Retrospective cohort study
Method: The Maryland SEDD was used to identify patients with an admitting diagnosis of Bell’s Palsy. Multivariate-adjusted regression analysis determined predictors of CT/MRI.
Results: There were 12,374 patients identified from 2008-2014 (pre-guidelines), and 13,031 from 2014-2018 (post-guidelines). Patients evaluated post-guidelines were older (median age 47 years vs 42 years, p<0.001) and more frequently covered by Medicare/Medicaid (44% vs 31%, p<0.001). In unadjusted analysis, there was no difference in imaging rates pre- (49.3%) versus post- (49.6%) guidelines (p=0.64). After controlling for demographic/socioeconomic variables, post-guidelines patients were less likely to receive imaging (OR=0.93, 95% CI=0.89-0.99). Patients in the top income quartile (OR=1.17, 95% CI=1.05-1.31) were more likely to receive imaging while females (OR=0.92, 95% CI=0.87-0.96) and Black patients (OR=0.77, 95% CI=0.73-0.82) were less likely to receive imaging. Patients utilizing Medicaid (OR=1.19, 95% CI=1.07-1.32)/private insurance (OR=1.62, 95% CI=1.49-1.77) were more likely to receive imaging than those on Medicare.
Conclusion: CT/MRI utilization decreased in Maryland after the AAO-HNSF guidelines for Bell’s Palsy were published. These data suggest that evidence-based guidelines may reduce unnecessary imaging, especially significant within Maryland’s All-Payer Model promoting value-based care.