Rapid Rise in CT Scanning in ERs Linked with Decline in Hospital Admissions

The accompanying editorial noted that the reduction in hospitalizations is a beneficial result for both patients and the healthcare system. “Almost one-quarter of CT scans performed in the US 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, MPH, of the University of Michigan (Ann Arbor, USA). “We saw a more dramatic rise in CT use among older patients. But we also saw an associated decline in post-CT hospitalizations.”

Assessing emergency department visits from 1996 to 2007, researchers found an increase of CT use from 3.2% of patient visits to 13.9%. 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%. By the end of the study period, 2007, that rate had dropped by more than half to 12.1%. Researchers found a similar pattern of declining risk of admission or transfer to intensive care units during the period.

In an editorial accompanying the study, Dr. Robert Wears, MD, MS, of the University of Florida Health Science Center offered “the desire for greater certainty” among emergency physicians as 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 Dr. Wears.

A 2010 study showed that patients with abdominal pain express more confidence in their medical treatment if it includes a CT scan. Dr. Kocher suggests that patients and families ask if a CT scan is necessary, given some of the risks related to radiation exposure from these tests, “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 Dr. Kocher. “I encourage patients and their families to ask the provider if they think the scan is really necessary. This allows open discussion about the necessity of the test and the patient’s or family’s expectations, and allows patients to be more involved in decision-making around their care.”

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