Increasing use of CT requested by emergency department physicians in tertiary hospitals in Western Australia 2003–2015: an analysis of linked administrative data

Abstract

ObjectiveThis study aimed to examine trends in number of CT scans requested by tertiary emergency department (ED) physicians in Western Australia (WA) from 2003 to 2015 across broad demographic and presentation characteristics, anatomical areas and presented symptoms.DesignAn observational cross-sectional study over study period from 2003 to 2015.SettingLinked administrative health service data at individual level from WA.ParticipantsA total of 1 666 884 tertiary hospital ED presentations of people aged 18 years or older were included in this studyMain outcome measureNumber of CT scans requested by tertiary ED physicians in an ED presentation.MethodsPoisson regression models were used to assess variation and trends in number of CT scans requested by ED physicians across demographic characteristics, clinical presentation characteristics and anatomical areas.ResultsOver the entire study duration, 71 per 1000 ED episodes had a CT requested by tertiary ED physicians. Between 2003 and 2015, the rate of CT scanning almost doubled from 58 to 105 per 1000 ED presentations. After adjusted for all observed characteristics, the rate of CT scans showed a downward trend from 2009 to 2011 and subsequent increase. Males, older individuals, those attending ED as a result of pain, those with neurological symptoms or injury or with higher priority triage code were the most likely to have CT requested by tertiary ED physicians.ConclusionsNoticeable changes in the number of CTs requested by tertiary ED physicians corresponded to the time frame of major health reforms happening within WA and nationally.

The use of computed tomography in the management of injury in tertiary emergency departments in Western Australia: Evidence of overtesting?

“…Interestingly, the highest growth of CT use was observed among ED presentations in the semi-/nonurgent category (+256%), particularly from 2012 onward. Although the growth coincided with major health reforms happening in Australia in 2012 (National Emergency Access Target and Activity-Based Funding Model) discussed in a previous study, 11 other changes in practice may also explain the growth. For example, there is increasing appreciation of the unreliability of plain x-ray in line with increasing evidence that standard plain radiography can miss at least 50% of all cervical fractures.…”

“…[7][8][9][10] In Australia, a recent study found that the use of CT in tertiary (teaching) hospital EDs increased from 81 to 200 per 1,000 presentations with injury between 2003 and 2015. 11 Compared to nonionizing radiation imaging techniques and plain X-ray, CT scanning is a relatively high-radiation-dose diagnostic imaging technique and carries a small but nonnegligible absolute long-term risk to the patient of radiation-induced malignancy. 12 Despite improved technology leading to significant dose reduction for individual scans, its increasing use has attracted attention from the public, media, researchers, and health care providers about the health impacts caused by increasing radiation exposure to the population.…”

Trend in CT utilisation and its impact on length of stay, readmission and hospital mortality in Western Australia tertiary hospitals: an analysis of linked administrative data 2003–2015

“…The pattern of consistent increase of readmissions and decrease in LOS across any, multiple and repeat CT also implies system changes, which could potentially be explained through changes in the Australian health system change, for example, the National Health Reform and Activity Based Funding Model (ABFM). 45 Financial reasons based on clinical activities within a hospitalisation could be linked to an earlier patient discharge (shorter LOS) to distribute activities across different hospitalisations for the same patient. In a systematic review and meta-analysis, Palmer et al 46 found that ABFM can cause an increase in readmission and a decrease in LOS, both of which were found in the present study.…”

The Incidence and Associated Risk Factors of Contrast-Induced Nephropathy after Contrast-Enhanced Computed Tomography in the Emergency Setting: A Systematic Review

“…Computed tomography (CT) utilization in the emergency department (ED) has been increasing globally over the years [ 1 , 2 ]. Iodinated contrast media (ICM) administration during contrast-enhanced CT (CECT) in the ED is crucial for the accurate diagnosis of acute conditions such as aortic dissection and pulmonary embolism [ 3 , 4 ].…”