Trends of CT Use in the Adult Emergency Department in a Tertiary Academic Hospital of Korea during 2001-2010

Abstract

ObjectiveWe wanted to assess the trends of CT examinations that were conducted in an adult emergency department (ED).Materials and MethodsWe searched the medical database to identify adult patients (≥ 18 years) who had visited the ED and the number of CT examinations of the patients during the period from January 2001 to December 2010. We also analyzed the types of CT scans performed in terms of body parts, they were as follows; head CTs, facial bone CTs, neckl CTs, chest CTs, abdominal CTs, and miscellaneous CTs. Further, miscellaneous CTs were subdivided as CT angiography and others.ResultsA total of 113656 CT scans were examined for 409439 adult ED patients during a 10-year period, and the number of CT scans increased by 255% (from 4743 CTs in 2001 to 16856 CTs in 2010), while the adult ED patient volume increased by 34% during the same period. Although the head CTs proportionally occupied the most, the facial bone CTs had the largest rate of increase (3118%), followed by cervical CTs (1173%), chest CTs (455%), miscellaneous CTs (388%; 862% and 84% for CT angiography and others, respectively), abdominal CTs (315%) and head CTs (95%) per 1000 patients during the decade.ConclusionCT use in adult ED has increased at a rate that far exceeds the growth of ED patient volume, with facial bone CTs and cervical CTs having the largest increasing rate, followed by chest CTs, miscellaneous CTs, abdominal CTs and head CTs.

Trends in computed tomography utilisation in the emergency department: A 5 year experience in an urban medical centre in northern Taiwan

“…The result of our research correlates with previous studies suggesting a dramatic increase in ED CT utilisation over the 5 year span of the study . The rate of increase outpaced the increase in ED patient volume.…”

“…Under global budget policy, the overall CAGR in Taiwan was 7.2% from 2005 to 2009. This was much lower than the 15.1% CAGR in Korea from 2001 to 2010, the 14.3% CAGR in the USA from 1996 to 2007 and the 12.4% CAGR in China from 2005 to 2008 . To our surprise, the total CT utilisation of 153 per 1000 ED visits in Taiwan in 2009 was the second highest compared with the 330 in Korea (in 2010), 139 in the USA (in 2007) and 139 in China (in 2008).…”

“…The result of our research correlates with previous studies suggesting a dramatic increase in ED CT utilisation over the 5 year span of the study. [6][7][8][9][10] The rate of increase outpaced the increase in ED patient volume. This trend may be observed because CT scans are fast, noninvasive, readily available in the ED and performed to achieve diagnostic certainty.…”

“…Various studies in the USA, Canada, China and Korea have shown a steady increase in the number of CT scans in the EDs. [6][7][8][9][10] However, as medical CT becomes more common, there are concerns about the magnitude of imaging-related financial costs, contrast-induced anaphylaxis, nephropathy and radiation-induced malignancies. 11,12 Given the fact that CT scans are expensive and National Health Insurance global budgets are limited in Taiwan, we postulated that the rate of increase of CT utilisation in Taiwan is different from that in developed countries; yet limited empirical data are available regarding this.…”

High positive computed tomography yields in the emergency department might not be a positive finding

“…They need to rapidly and accurately diagnose and decide on a patient's disposition, while making use of the least invasive modality of diagnostic testing. [5,6] In the ED setting, providers may tend to overutilise CT scans. [2,7] Other factors contributing to CT over-utilisation may include fear of a missed or incorrect diagnosis, the potential for malpractice lawsuits, as well as inadequate knowledge and awareness of radiation exposure and potential risk of inducing cancer.…”