Dustin Mark, MD
I love answering questions and doing a deep dive into things. At TPMG, I can pursue my academic interests while remaining at the bedside, which is where I prefer to be most of the time.
When a patient shows up in the emergency room with a sudden, painful headache, a CT scan is usually the first test the doctor orders. If the CT scan does not diagnose a severe, life-threatening brain hemorrhage, the next test recommended is a lumbar puncture, or spinal tap, an invasive test that takes more time to obtain results than scans and has a high rate of false-positives.
Over years of practice, Dustin Mark, MD, emergency medicine physician at KP Oakland, noticed that physicians seemed to be ordering noninvasive CT angiograms, a more-detailed scan with contrast dye, more often as a secondary diagnostic test.
“When we are faced with diagnostic dilemmas, there are lots of advantages to finding noninvasive methods of screening that are scientifically validated,” says Rita Ng, MD, FACC, physician-in-chief of KP East Bay.
With colleagues from the KP CREST Network of emergency department researchers, Dr. Mark designed what is believed to be the first study assessing changes in diagnostic strategies for sudden headaches with CT angiograms. “We wanted to quantify this trend and make sure that it was safe.”
The study, which reviewed more than 198,000 headache cases at 21 emergency departments across KP Northern California between 2015 and 2021, was published in JAMA Network Open in 2024 with co-investigators from the CREST Network. It found that CT angiograms were indeed being ordered as a secondary diagnostic tool more often than lumbar punctures, and that patient safety was not compromised by this trend. CT angiograms also identified more unruptured brain aneurysms, which provides an opportunity to monitor these patients going forward, though more studies are needed to determine the long term consequences.
“Dr. Mark has a knack for honing in on the clinically challenging problems that our physicians face,” says John W. Morehouse, MD, FACEP, physician-in-chief of KP East Bay. “This study shows that an imaging-forward approach is equivalent and effective, safe and efficient.”