Retrospective Analysis of Emergency Computed Tomography Imaging Utilization at an Academic Centre: An Analysis of Clinical Indications and Outcomes

Abstract

Purpose To explore resource utilization through evaluation of computed tomography (CT) imaging trends in the emergency department by examining common indications/outcomes for imaging in this setting. Methods A retrospective analysis of clinical indications/outcomes for all CT imaging in 3 emergency departments over a 1-year period was conducted. Scans were divided by body part and the most common indications for each type of scan were determined. Clinical outcomes from each study were extracted from final interpretations by the reporting radiologist. Results A total of 4556 CT scans were performed in the emergency department over a 1-year period. A total of 3.6% of all-comers to our emergency departments underwent CT scan as part of their investigation. There were 2107 head CTs (46%), 1296 (28%) abdominal CTs, 468 (10%) CTs of the chest, 408 (9%) CTs of the neck/spine, and 101 (2%) extremity CTs performed. The most common clinical indication for performing a CT head was focal neurological defect comprising 1534 (73%) of all CT heads. Twenty-four percent of abdominal CTs were for investigation of right lower quadrant pain, followed by flank pain (19%). Chest pain and shortness of breath were the most common indications for CTs of the chest (315 [75%]) with 10% of these examinations for this indication positive for pulmonary embolism. Trauma was the most common indication for neck CTs (296 [73%]) and extremities (70 [69%]). Nil acute was the most common final interpretation in all categories (79% CT heads, 75% neck CTs, 38% abdominal CTs, 43% chest CTs). Conclusions Nil acute was the most common diagnosis; however, serious clinical outcomes were identified 40% of the time. Cross-sectional imaging remains an integral tool for triage and diagnosis in this environment as the cost of missing a diagnosis in this setting has a great impact on patient care.

Acute traumatic brain injury presentations and the use of head CT scans in the Emergency Department

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Effectiveness of a 12-Month Emergency Radiology Curriculum for Improving Self-Confidence and Competence of Postgraduate Year 1 Radiology Residents—A Canadian Study

“…7 In normal emergency department imaging, a significant proportion of studies do not demonstrate any significant pathology. 7,15 Due to time constraints of testing, there may have been an unrealistic overrepresentation of emergent images with abnormal findings in our tests. There was a low course completion rate for this voluntary curriculum.…”

Chest computed tomography features of heart failure: A prospective observational study in patients with acute dyspnea

“…Chest computed tomography (CT) is the gold standard for diagnosing interstitial lung disease, but it is not a recommended test for AHF [2,7]. However, acute patients with dyspnea often undergo CT as the primary or secondary examination in the search for pulmonary embolus, acute coronary syndrome, or suspected pulmonary infection [8].…”