A recent study published August 23 in the American Journal of Roentgenology noted a significant increase in utilization of chest and abdominopelvic CT scans in emergency departments from 2011 to 2018. According to a team led by Dr. Ninad Salastekar of Emory University in Atlanta, the reasons are uncertain. The study provoked questions regarding overuse in trauma settings in emergency departments.
Salastekar and colleagues utilized commercial claims data gathered from the IBM MarketScan Commercial Database. There were 8.4 million emergency department trauma-related encounters from 2011 through 2018. The researchers tracked the severity of injury — classifying them as minor, intermediate, and major along with the type of CT exam — chest, abdominopelvic, or thoracoabdominopelvic. Then they calculated the number of CT scans per 1,000 trauma-related ED encounters.
Over two-thirds of the trauma-related ED visits were minor (5.7 million, 67.9%). Moderate trauma-related ED encounters numbered 2.6 million. Only 58,853 emergency department trauma visits were major. But researchers discovered that the use of CT scans over the study period increased, particularly for thoracoabdominopelvic CT studies.
CT Scan Exams in ED Departments per 1,000 Trauma Visits
| Chest | 2011 | 2018 |
| Minor | 2.2 | 7.7 |
| Intermediate | 8.5 | 21.5 |
| Major | 117.8 | 200.1 |
| Abdominopelvic CT | 2011 | 2018 |
| Minor | 4.8 | 12.2 |
| Intermediate | 10.6 | 21.7 |
| Major | 134.8 | 192.6 |
| Thoracoabdominopelvic CT | 2011 | 2018 |
| Minor | 1.1 | 4.6 |
| Intermediate | 6.4 | 16.4 |
| Major | 99.6 | 179.9 |
Across the board, the number of CT exams per 1,000 trauma visits dramatically increased regardless of trauma severity or exam type. Yet, researchers found that the proliferation in computed tomography did not transform into quicker diagnoses or increased levels of hospitalizations, “suggesting that the utilization increase may in part represent inappropriate imaging.”
The researchers further noted, “The increase in utilization of CT in the emergency department setting has raised a range of concerns. The growing use of CT contributes to increases in healthcare costs and downstream resource utilization, as well as potential care delays.”
Researchers also suggested more studies into the significant increase in single-encounter thoracabdominopelvic CT examinations and the increases among those with minor trauma-related events.