Surge in CT Scans for Patients with Minor Injuries

A new study reveals that almost twice as many patients with non-serious injuries are undergoing computerized tomography (CT) scans in the emergency department (ED) compared to a decade ago.

Researchers at the University of California, San Francisco (UCSF; USA) and Stanford University (CA, USA) conducted a retrospective analysis of the California Office of Statewide Health Planning and Development (Sacramento, USA) emergency department and ambulatory surgery data from 2005 to 2013. A total of 8,535,831 adult patients were identified with an injury severity score lower than 9 who were discharged home. The primary outcome measure was prevalence of CT imaging for each year, and clinical and hospital-level factors related to CT use.

The results showed that 5.9% of the study population received at least one CT study during their ED visit, with the proportion of patients with at least one CT scan increasing from 3.51% in 2005 to 7.17% in 2013. Predictors for CT administration included age (18-24 years, or older than 45 years), Medicare and self-pay patients, fall injuries, motor vehicle collision injuries, and patients seen at level I/II trauma centers (39%), compared with 3% at low-level centers. The study was published on January 19, 2016, in the Journal of Surgical Research.

“The reasons for this increase are multifactorial,” said senior author Renee Hsia, MD, a professor of emergency medicine and health policy at UCSF. “They range from defensive medicine practices, the superior diagnostic accuracy of CT scans compared with X-rays, to their increased availability and convenience in emergency departments, and the demand to expedite discharge of patients.”

“The message for both patients and physicians is that there are long-term risks associated with radiation exposure and there may be situations where imaging is not definitively warranted or beneficial,” concluded Dr. Hsia. “We can't conclusively say which cases should not involve imaging, since every patient and every circumstance is different, but given that it is getting easier and easier to get CT scans, we need to be cautious in weighing their risks and benefits.”

Related Links:
University of California, San Francisco
Stanford University
California Office of Statewide Health Planning and Development