National Trends in Use of Computed Tomography in the Emergency Department

• Published in: Annals of emergency medicine Vol. 58; no. 5; pp. 452 - 462.e3
• Main Authors: Kocher, Keith E., MD, MPH, Meurer, William J., MD, MS, Fazel, Reza, MD, MSc, Scott, Phillip A., MD, Krumholz, Harlan M., MD, SM, Nallamothu, Brahmajee K., MD, MPH
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.11.2011; Elsevier
• Subjects: Adolescent; Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Emergency; Emergency and intensive care: techniques, logistics; Emergency Service, Hospital - statistics & numerical data; Female; Flank Pain; Health Care Surveys; Humans; Intensive care medicine; Intensive care unit. Emergency transport systems. Emergency, hospital ward; Logistic Models; Male; Medical sciences; Middle Aged; Outcome Assessment (Health Care); Retrospective Studies; Tomography, X-Ray Computed - trends; Tomography, X-Ray Computed - utilization; United States; Young Adult; United States; Intensive care; Computerized axial tomography; Emergency department; Resuscitation
• ISSN: 0196-0644; 1097-6760
• DOI: 10.1016/j.annemergmed.2011.05.020

Study objective The role of computed tomography (CT) in acute illnesses has increased substantially in recent years; however, little is known about how CT use in the emergency department (ED) has changed over time. Methods A retrospective study was performed with the 1996 to 2007 National Hospital Ambulatory Medical Care Survey, a large nationwide survey of ED services. We assessed changes during this period in CT use during an ED visit, CT use for specific ED presenting complaints, and disposition after CT use. Main outcomes were presented as adjusted risk ratios (RRs). Results Data from 368,680 patient visits during the 12-year period yielded results for an estimated 1.29 billion weighted ED encounters, among which an estimated 97.1 million (7.5%) patients received at least one CT. Overall, CT use during ED visits increased 330%, from 3.2% of encounters (95% confidence interval [CI] 2.9% to 3.6%) in 1996 to 13.9% (95% CI 12.8% to 14.9%) in 2007. Among the 20 most common complaints presenting to the ED, there was universal increase in CT use. Rates of growth were highest for abdominal pain (adjusted RR comparing 2007 to 1996=9.97; 95% CI 7.47 to 12.02), flank pain (adjusted RR 9.24; 95% CI 6.22 to 11.51), chest pain (adjusted RR 5.54; 95% CI 3.75 to 7.53), and shortness of breath (adjusted RR 5.28; 95% CI 2.76 to 8.34). In multivariable modeling, the likelihood of admission or transfer after a CT scan decreased over the years but has leveled off more recently (adjusted RR comparing admission or transfer after CT in 2007 to 1996=0.42; 95% CI 0.32 to 0.55). Conclusion CT use in the ED has increased significantly in recent years across a broad range of presenting complaints. The increase has been associated with a decline in admissions or transfers after CT use, although this effect has stabilized more recently.