Abstract
This study aims to characterize changes in computed tomography (CT) utilization in the adult emergency department (ED) over a 5-year period. CT scans ordered on adult ED patients from July 2000 to July 2005 were analyzed in five groups: head, cervical spine, chest, abdomen, and miscellaneous. ED patient volume and triage acuity scores were determined. Triage acuity scores are used to determine the severity of a patient’s illness or injury and the need for immediate evaluation and treatment. There were 46,553 CT scans performed on 27,625 adult patients in the ED during the study period. During this same period, 194,622 adult patients were evaluated in the ED. From 2000 to 2005, the adult emergency department patient volume increased by 13% while triage acuity remained stable. During this same period, head CT increased by 51%, cervical spine CT by 463%, chest CT by 226%, abdominal CT by 72%, and miscellaneous CT by 132%. Although increases were generally greater for patients over age 40, the increase in those less than 40 years was also substantial. Of the 4,320 individual patients who underwent chest CT, 83 (2%) had chest CT on three or more separate ED visits. Of 10,960 patients undergoing abdominal CT, 406 (4%) had abdominal CT on three or more separate ED visits. ED CT utilization has increased at a rate far exceeding the growth in ED patient volume. This presumably reflects the improved utility of CT in diagnosing serious pathology, its increased availability, and a desire on the part of physicians for diagnostic certainty. Whether this increase in utilization results in improved patient outcomes is at present unclear and deserves additional study.
Similar content being viewed by others
References
Margulis AR, Bhargavan M, Feldman D, Sunshine JH (2005) Should the ordering of medical imaging examinations be reexamined? J Am Coll Rad 2:809–811
Prologo JD, Gilkeson RC, Diaz M, Asaad J (2004) CT pulmonary angiography: a comparative analysis of the utilization patterns in emergency department and hospitalized patients between 1998 and 2003. AJR Am J Roentgenol 183:1093–1096
Oguz KK, Yousem DM, Deluca T, Herskovits EH, Beauchamp NJ (2002) Effect of emergency department CT on neuroimaging case volume and positive scan rates. Acad Radiol 9:1018–1024
Donnelly LF (2005) Reducing radiation dose associated with pediatric CT by decreasing unnecessary examinations. AJR Am J Roentgenol 184:655–657
Brenner DJ, Elliston C, Hall E, Berdon W (2001) Estimated risks of radiation induced fatal cancer from pediatric CT. AJR Am J Roentgenol 176:289–296
Hall E (2002) Lessons we have learned from our children: cancer risks from diagnostic radiology. Pediatr Radiol 32:700–706
Tanabe P, Gimbel R, Yarnold PR, Kyriacou DN, Adams JG (2004) Reliability and validity of scores on the emergency severity index version 3. Acad Emerg Med 11:59–65
Kalra M, Maher M, Saini S (2003) CT radiation exposure: rationale for concern and strategies for dose reduction. Proceedings from the SCBT/MR. Appl Radiol 7:45–54
Mettler FA, Wiest PW, Locken JA, Kelsey CA (2000) CT scanning: patterns of use and dose. J Radiol Prot 20:353–359
Brenner DJ, Elliston C (2004) Estimated radiation risks potentially associated with full-body CT screening. Radiology 232:735–738
Mulkens T, Bellinck P, Baeyaert M et al (2005) Use of an automatic exposure control mechanism for dose optimization in multidetector row CT examinations: clinical evaluation. Radiology 237:213–223
Wall BF, Hart D (1997) Revised radiation doses for typical X-ray examinations. Br J Radiol 70:437–439
Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation, National Research Council (2005) Health risks from exposure to low levels of ionizing radiation: BEIR VII phase 2. National Academies, Washington, DC
Parker MS, Hui FK, Camacho MA, Chung JK, Broga DW, Sethi NN (2005) Female breast radiation exposure during CT pulmonary angiography. AJR Am J Roentgenol 185:1228–1233
Kalra M, Maher M, Toth T et al (2004) Strategies for CT radiation dose optimization. Radiology 230:619–628
Fefferman N, Bomsztyk E, Yim A et al (2005) Appendicitis in children: low-dose CT with a phantom-based simulation technique—initial observations. Radiology 237:641–646
Nakayama Y, Awai K, Funama Y et al (2005) Abdominal CT with low tube voltage: preliminary observations about radiation dose, contrast enhancement, image quality, and noise. Radiology 237:945–951
Nickoloff E, Alderson P (2001) Radiation exposures to patients from CT: reality, public perception, and policy. AJR Am J Roentgenol 177:85–287
Feigal DW Jr (2001) FDA public health notification: reducing radiation risk from computed tomography for pediatric and small adult patients. Int J Trauma Nurs 8:1–2
Booz AH (2003) Medical technology cost management strategy. Report prepared for the Blue Cross and Blue Shield Association. Chicago
McCaig LF, Burt CW (2005) National hospital ambulatory medical care survey: 2003 emergency department summary. National Center for Health Statistics, Hyattsville, Maryland, pp 1–40
Gottlieb RH, La TC, Erturk EN et al (2002) CT in detecting urinary tract calculi: influence on patient imaging and clinical outcomes. Radiology 225:441–449
Chen MYM, Zagoria RJ, Saunders HS, Dyer RB (1999) Trends in the use of unenhanced helical CT for acute urinary colic. AJR Am J Roentgenol 173:1447–1450
Shiralkar S, Rennie A, Snow M, Galland R, Lewis M, Gower-Thomas K (2003) Doctor’s knowledge of radiation exposure: questionnaire study. BMJ 327:371–372
Lee CI, Haims AH, Monico EP, Brink JA, Forman HP (2004) Diagnostic CT scans: assessment of patient, physician, and radiologist awareness of radiation dose and possible risks. Radiology 231:393–398
Stiell IG, Wells GA, Vandemheen KL et al (2001) The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA 286:1841–1848
Stiell IG, Clement CM, McKnight RD et al (2003) The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. NEJM 349:2510–2518
Runyon MS, Webb WB, Jones AE, Kline JA (2005) Comparison of the unstructured clinician estimate of pretest probability for pulmonary embolism to the Canadian score and the Charlotte rule: a prospective observational study. Acad Emerg Med 12:587–593
Investigators WGftCS (2006) Effectiveness of managing suspected pulmonary embolism using an algorithm combining clinical probability, D-dimer testing and computed tomography. JAMA 295:172–179
White CS, Kuo D, Kelemen M et al (2005) Chest pain evaluation in the emergency department: can MDCT provide a comprehensive evaluation? AJR Am J Roentgenol 185:533–540
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Broder, J., Warshauer, D.M. Increasing utilization of computed tomography in the adult emergency department, 2000–2005. Emerg Radiol 13, 25–30 (2006). https://doi.org/10.1007/s10140-006-0493-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10140-006-0493-9