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From 1998 to 2007, the use of CT or MRI scans in emergency departments for injury-related conditions increased about 3-fold without a similar increase in the prevalence of the diagnosis of certain life-threatening trauma-related conditions, according to a study in the Oct. 6 issue of JAMA. Injury-related conditions are among the most common reasons for visits to emergency departments in the United States. “The widespread availability of advanced radiology (computed tomography ( CT ) and magnetic resonance imaging ( MRI )) and the associated diagnostic superiority in identifying significant injuries have made these tools important in the evaluation of patients presenting to emergency departments,” the authors write. They add that increased use of these procedures is associated with increased health care expenditures, increased length of stay in the emergency department and increased exposure to ionizing radiation.

Frederick Kofi Korley, M.D., of Johns Hopkins University, Baltimore, and colleagues examined the national trends in the use of advanced radiology during emergency department visits for injury-related conditions over a 10-year period (1998-2007), using data from the National Hospital Ambulatory Medical Care Survey. Sampled visits were weighted to produce estimates for the United States. Between 1998 and 2007, a total of 324,569 emergency department visits were sampled. Of these, 65,376 presented with injury-related conditions (20 percent), representing an estimated average of 22.4 million visits made to emergency departments in the United States each year for injury-related conditions. Visits were sampled from an average of 370 hospitals per year.

Of the 5,237 visits for injury-related conditions sampled in 1998, 257 patients received CT or MRI (6 percent); in 2007, of the 6,567 visits sampled, 981 patients received CT or MRI (15 percent). Analysis indicated that patients who presented to the emergency department for injury-related conditions in 2007 were about 3 times more likely to receive a CT or MRI compared with similar emergency department visits in 1998. Increase in CT use accounted for the majority of the increased CT or MRI use.

“Some factors that may have contributed to this significant increase in CT use are the superiority of CT scans over x-rays for diagnosing conditions such as cervical spine fractures, the routine use of whole-body scanning for patients treated in some trauma centers, the increased availability of CT scanners, the proximity of CT scanners to the patient care areas of most emergency departments, the speed of new-generation CT scanners leading to a decrease in the need to sedate pediatric patients, and concern about malpractice lawsuits for a missed diagnosis,” the authors write.

Source: JAMA

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