Almost 25 percent of tests performed in ED
WASHINGTON – CT scans in the emergency room have gone up dramatically in recent years. A new study links the increase in CT scans to fewer hospital admissions.
The use of CT scans in emergency departments increased 330 percent between 1996 and 2007, according to a study published online on Aug. 9 in the Annals of Emergency Medicine, a peer-reviewed scientific journal for the American College of Emergency Physicians.
Authors of the study said the resulting reduction in hospitalizations is beneficial for both patients and the healthcare system.
“We saw a more dramatic rise in CT use among older patients. But, we also saw an associated decline in post-CT hospitalizations,” Kocher said.
The study assessed emergency department visits from 1996 to 2007. Researchers found an increase of CT use from 3.2 percent of patient visits to 13.9 percent. Rates of growth were highest for abdominal pain, flank pain, chest pain and shortness of breath, all of which can be symptoms of life-threatening emergencies.
In 1996, the rate of hospitalization following CT scan was 26 percent. By the end of the study period, 2007, that rate had dropped by more than half to 12.1 percent. Researchers found a similar pattern of declining risk of admission or transfer to intensive care units during the period.
“Almost one-quarter of CT scans performed in the U.S. are performed in ERs, in part because primary care and other physicians refer their patients there for these studies and also because we are increasingly being asked to do all the initial tests for patients in the ER before a patient is admitted to the hospital,” said lead study author Keith Kocher, MD, of the University of Michigan in Ann Arbor.
In an editorial accompanying the study, Robert Wears, MD, of the University of Florida Health Science Center said the “desire for greater certainty” among emergency physicians was one reason for the increase, particularly in light of the high-risk environment of the emergency department and the potential for litigation by patients with bad outcomes.
“The occasional ‘near miss,’ where one manages a patient without imaging, only to discover later that they had CT-detectable pathology of some sort that could have been detected sooner reinforces the desire for greater certainty,” said Wears.
“Patients or their family members sometimes want – or even expect – these advanced tests to be done, so emergency physicians may be more likely to order them,” said Kocher. “I encourage patients and their families to ask the provider if they think the scan is really necessary.”