Computed Tomography Use in the Adult Emergency Department of an Academic Urban Hospital From 2001 to 2007

• Published in: Annals of emergency medicine Vol. 56; no. 6; pp. 591 - 596.e1
• Main Authors: Lee, Jarone, MD, MPH, Kirschner, Jonathan, MD, Pawa, Sapna, MD, Wiener, Dan E., MD, Newman, David H., MD, Shah, Kaushal, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.12.2010; Elsevier
• Subjects: Academic Medical Centers - statistics & numerical data; Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Confidence Intervals; Emergency; Emergency and intensive care: techniques, logistics; Emergency Service, Hospital - statistics & numerical data; Facial Bones - diagnostic imaging; Female; Head - diagnostic imaging; Hospitals, Urban - statistics & numerical data; Humans; Intensive care medicine; Intensive care unit. Emergency transport systems. Emergency, hospital ward; Linear Models; Male; Medical sciences; Middle Aged; Neck - diagnostic imaging; New York City; Pelvis - diagnostic imaging; Radiography, Abdominal - methods; Radiography, Abdominal - statistics & numerical data; Radiography, Thoracic - methods; Radiography, Thoracic - statistics & numerical data; Tomography, X-Ray Computed - statistics & numerical data; Tomography, X-Ray Computed - utilization; Young Adult; Intensive care; Computerized axial tomography; Urban area; Emergency department; Resuscitation
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/j.annemergmed.2010.05.027

Study objective There is both increasing recognition and growing scrutiny of the increased utilization of computed tomography (CT) in medicine. For our primary objective, we determine and quantify the CT utilization rate in our emergency department (ED) during the last 7 years. As a secondary objective, we compare trends in utilization for various types of CT scans. Methods We performed an electronic chart review at our inner-city, academic ED with an annual census of 110,000 patients. We identified all patients older than 21 years who had a CT scan performed during ED management from January 2001 to December 2007. Specific, predetermined data elements (eg, subject demographics, type of CT scan) were extracted on standardized data forms by trained abstractors. We analyzed our data with standard descriptive statistics and linear regression. Results The rate of CT utilization increased steadily at approximately 10 CTs per 1,000 (95% confidence interval 7.5 to 13.6 CTs) patients annually during our study period, from 51 per 1,000 patient visits in 2001 to 106 per 1,000 in 2007. Among these CTs, chest CTs increased most, with a 6-fold increase from 10 per 1,000 patient visits to 60 per 1,000. Neck CTs increased by 5-fold, from 20 per 1,000 patient visits to 100 per 1,000 patients. Similarly, the utilization of abdomen-pelvis CTs, facial bone CTs, and head CTs increased from 13 per 1,000 to 33 per 1,000 patient visits (150%), 1 per 1,000 to 2 per 1,000 patient visits (100%), and 33 per 1,000 to 53 per 1,000 patient visits (60%), respectively. Conclusion Recent CT utilization in our ED increased in all anatomic categories assessed, with chest CTs and neck CTs increasing the most, followed by abdomen-pelvis CTs, facial bone CTs, and head CTs.