The Association Between Head and Neck CT Angiography, Consultation, and Increased Emergency Department Length of Stay

Providers increasingly use CT angiography of the head and neck (CTA H/N) in the Emergency Department (ED) to evaluate patients with suspected neurologic pathology. Although the diagnostic value is established, downstream implications on ED length of stay (LOS) and need for specialty consultation remain poorly characterized. Given ED boarding, understanding the operational effect of neuroimaging is critical in optimizing patient flow, resource utilization, and throughput. This study aims to quantify differences in ED LOS among patients undergoing CTA H/N, stratified by involvement of specialty consultation.

We conducted a retrospective cohort study of 20,234 adults presenting with a neurologic chief complaint to an urban, academic ED from June 2024 to August 2025. We analyzed the effects of completed CTA H/N and consultation to neurology, neurosurgery, vascular surgery, or spine surgery, on our primary outcome, ED LOS, defined as time from ED arrival to departure. Those who left without being seen or eloped were excluded. Quantile regression was used to estimate median LOS differences associated with CTA H/N and specialty consultation, both unadjusted and adjusted for age, sex, and Emergency Severity Index (ESI).

Unadjusted, presence of CTA increased LOS by 1.2 (95% CI: 0.6-1.9, p<0.001) hours and presence of consult increased LOS by 3.6 (95% CI: 3.3-3.8, p<0.001) hours. There was no association between the presence of CTA and the presence of consult (p=0.903). Adjusting for age, sex, and ESI, presence of CTA increased LOS by 1.0 (95% CI: 0.3-1.6, p=0.003) hours and presence of consult increased LOS by 3.0 (95% CI: 2.7-3.2, p<0.001) hours. There was no evidence of interaction between the presence of CTA and the presence of consult (p=0.941).

Among ED patients with neurologic complaints, CTA H/N and consultation are both associated with longer LOS, highlighting a need for streamlined CTA ordering guidelines and workflows, and consult pathways to balance diagnostic evaluation with operational efficiency in high-acuity settings. The data also highlights the lack of interaction between CTA and consult on LOS, and the magnitude of consultation delays, which were threefold larger than CTA-related delays. Optimizing LOS could improve the crisis of ED boarding and crowding. Limitations include generalizability, especially to EDs without 24/7 CTA or consultant availability.