National Trends in Use of Computed Tomography in the Emergency Department - 19/10/11
, William J. Meurer, MD, MS a, Reza Fazel, MD, MSc c, Phillip A. Scott, MD a, Harlan M. Krumholz, MD, SM d, Brahmajee K. Nallamothu, MD, MPH b, e
Address for correspondence: Keith Kocher, MD, MPHRésumé |
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.
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| Author contributions: KEK was responsible for study concept and design, data acquisition, and statistical analysis; had full access to all of the data in the study; and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors analyzed and interpreted the data and critically revised the article for important intellectual content. KEK and BKN drafted the article and supervised the study. KEK takes responsibility for the paper as a whole. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. |
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| Publication date: Available online August 11, 2011. |
Vol 58 - N° 5
P. 452 - novembre 2011 Retour au numéro
Article précédent
- Commentary: Update on Emerging Infections: News From the Centers for Disease Control and Prevention
- Stephen Y. Liang, Jonas Marschall
- Computed Tomography Imaging in the Emergency Department: Benefits, Risks and Risk Ratios
- Tyler W. Barrett, David L. Schriger
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