The Increasing Use of Emergency Department Imaging in the United States: Is It Appropriate?

Selvarajan, Santosh Kumar; Levin, David C.; Parker, Laurence

doi:10.2214/ajr.19.21386

Cited by 63 publications

(33 citation statements)

References 19 publications

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“…Several studies have shown that ED imaging volume decreased substantially during the COVID-19 pandemic [ 3 , 4 , 6 ]. This contrasts with the prepandemic trend in ED imaging, particularly CT, which had been increasing for the past decade [ 14 – 16 ], as convincing data has shown that early CT diagnosis of certain conditions, such as appendicitis and uncomplicated diverticulitis, reduces hospital resource use and improves patient outcomes [ 17 , 18 ]. There are several potential reasons why ED CT volume decreased during the COVID-19 pandemic, as one would expect the incidence of diseases requiring an abdominopelvic CT in the ED should remain constant or increased.…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on emergency department CT for suspected diverticulitis

et al. 2020

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Purpose This study examined the impact of the COVID-19 pandemic on emergency department CT use for acute nontraumatic abdominal pain, to better understand why imaging volume so drastically decreased during the COVID-19 pandemic. Methods This was a retrospective review of emergency imaging volumes from January 5 to May 30, 2020. Weekly volume data were collected for total imaging studies, abdominopelvic CT, and abdominopelvic CTs positive for common causes of acute nontraumatic abdominal pain. Two emergency radiology attendings scored all diverticulitis cases independently, and weekly volume data for uncomplicated and complicated diverticulitis cases was also collected. Volume data prior to and during the COVID-19 pandemic was compared, using 2019 volumes as a control. Results During the COVID-19 pandemic, overall emergency imaging volume decreased 30% compared to 2019 ( p = 0.002). While the number of emergency abdominopelvic CTs positive for appendicitis and small bowel obstruction did not significantly change during the COVID-19 pandemic, the number of cases of diverticulitis decreased significantly compared to 2019 ( p = 0.001). This reduction can be specifically attributed to decreased uncomplicated diverticulitis cases, as the number of uncomplicated diverticulitis cases dropped significantly ( p = 0.002) while there was no significant difference in the number of complicated diverticulitis cases ( p = 0.09). Conclusions Reduced emergency abdominopelvic CT volume during the COVID-19 pandemic can partially be explained by decreased imaging of lower acuity patients. This data may help formulate future strategies for imaging resource utilization with an improved understanding of the relationship between perceived imaging risk and symptom acuity.

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Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 pandemic on emergency department CT for suspected diverticulitis

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Several studies have shown that ED imaging volume decreased substantially during the COVID-19 pandemic [3,4,6]. This contrasts with the pre-pandemic trend in ED imaging, particularly CT, which had been increasing for the past decade [14][15][16], as convincing data has shown that early CT diagnosis of certain conditions, such as appendicitis and uncomplicated diverticulitis, reduces hospital resource use and improves patient outcomes [17,18]. There are several potential reasons why ED CT volume decreased during the COVID-19 pandemic, as one would expect the incidence of diseases requiring an abdominopelvic CT in the ED should remain constant or increased.…”

Section: Discussionmentioning

confidence: 94%

Impact of the COVID-19 pandemic on emergency department CT for suspected diverticulitis: A natural experiment to explain patients’ and clinicians’ assessment of risk and willingness to undergo CT scanning?

Gibson

Chen

Rosen

et al. 2020

Preprint

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Purpose: This study examined the impact of the COVID-19 pandemic on emergency department CT use for acute non-traumatic abdominal pain, to better understand why imaging volume so drastically decreased during the COVID-19 pandemic.Methods: This was a retrospective review of emergency imaging volumes from January 5 to May 30, 2020. Weekly volume data were collected for total imaging studies, abdominopelvic CT, and abdominopelvic CTs positive for common causes of acute non-traumatic abdominal pain. Two emergency radiology attendings scored all diverticulitis cases independently and weekly volume data for uncomplicated and complicated diverticulitis cases was also collected. Volume data prior to and during the COVID-19 pandemic was compared, using 2019 volumes as a control.Results: During the COVID-19 pandemic, overall emergency imaging volume decreased 30% compared to 2019 (p = 0.002). While the number of emergency abdominopelvic CTs positive for appendicitis and small bowel obstruction did not significantly change during the COVID-19 pandemic, the number of cases of diverticulitis decreased significantly compared to 2019 (p = 0.001). This reduction can be specifically attributed to decreased uncomplicated diverticulitis cases, as the number of uncomplicated diverticulitis cases dropped significantly (p = 0.002) while there was no significant difference in the number of complicated diverticulitis cases (p = 0.09). Conclusions: Reduced emergency abdominopelvic CT volume during the COVID-19 pandemic can partially be explained by decreased imaging of lower acuity patients. This data may help formulate future strategies for imaging resource utilization with an improved understanding of the relationship between perceived imaging risk and symptom acuity.

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“…The incidence of RI in the ED was 0.015% during our study period, which is higher than the previously reported rate of 0.004–0.007% [ 2 , 3 ]. The reason why the incidence rate of RI is higher in our study is that the rate of use of CT relative to patient number in the ED has been gradually increasing over time, so the diagnostic rate of RI might have increased [ 18 , 19 ]. Also, as the need for contrast CT was determined by the clinician who treated each patient, there may be a difference in the diagnostic rate of RI due to each clinician’s experience and skill level.…”

Section: Discussionmentioning

confidence: 99%

Predictors of renal infarction in patients presenting to the emergency department with flank pain: A retrospective observational study

et al. 2021

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Objectives Flank pain is a common symptom in the emergency department and can be caused by a variety of diseases. Renal infarction (RI) is a very rare disease, and many RI patients complain of flank pain. However, there is no definitive predictor of RI when patients complain of flank pain. This study aimed to identify the clinical factors for predicting RI in patients with flank pain. Methods This retrospective single-center study was conducted on patients complaining of flank pain from January 2016 to March 2020 at a South Korean tertiary care hospital. Exclusion criteria included patients who did not undergo contrast-enhanced computed tomography, age < 18 years, and trauma. Demographic and laboratory data were obtained from medical records. Logistic regression analysis was conducted to identify predictors of RI occurrence. Results In all, 2,131 patients were enrolled, and 39 (1.8%) had RI. From a multivariable logistic regression analysis, an age ≥ 65 years (odds ratio [OR], 3.249; 95% confidence interval [CI], 1.366–7.725; p = 0.008), male sex (OR, 2.846; 95% CI, 1.190–6.808; p = 0.019), atrial fibrillation (OR, 10.386; 95% CI, 3.724–28.961; p < 0.001), current smoker (OR, 10.022; 95% CI, 4.565–22.001; p < 0.001), and no hematuria (OR, 0.267; 95% CI, 0.114–0.628; p = 0.002) were significantly associated with the occurrence of RI. Conclusions Five clinical factors, i.e., age ≥ 65 years, male sex, atrial fibrillation, current smoker, and no hematuria, were significantly associated with the occurrence of RI in patients with flank pain.

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The Increasing Use of Emergency Department Imaging in the United States: Is It Appropriate?

Cited by 63 publications

References 19 publications

Impact of the COVID-19 pandemic on emergency department CT for suspected diverticulitis

Impact of the COVID-19 pandemic on emergency department CT for suspected diverticulitis

Impact of the COVID-19 pandemic on emergency department CT for suspected diverticulitis: A natural experiment to explain patients’ and clinicians’ assessment of risk and willingness to undergo CT scanning?

Predictors of renal infarction in patients presenting to the emergency department with flank pain: A retrospective observational study

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