Use of Advanced Radiology During Visits to US Emergency Departments for Injury-Related Conditions, 1998-2007

Abstract

Context Excessive use of medical imaging increases health care costs and exposure to ionizing radiation (a potential carcinogen) without yielding significant benefits to all patients. Objective To determine whether there has been a change in the prevalence of emergency department visits for injury-related conditions for which computed tomography (CT) or magnetic resonance imaging (MRI) was obtained and whether there has been a change in the diagnosis of life-threatening conditions and patient disposition. Design, Setting, and Participants Retrospective cross-sectional analysis of emergency department visits using data from the National Hospital Ambulatory Medical Care Survey (1998-2007). Sampled visits were weighted to produce estimates for the United States. Main Outcomes Measures Proportion of visits for injury-related conditions during which a CT or MRI was obtained, a life-threatening condition was diagnosed (eg, cervical spine fracture, skull fracture, intracranial bleeding, liver and spleen laceration), and which resulted in hospital and intensive care unit admission. Results The prevalence of CT or MRI use during emergency department visits for injury-related conditions increased from 6% (95% confidence interval [CI], 5%-7%) (257 of 5237 visits) in 1998 to 15% (95% CI, 14%-17%) (981 of 6567 visits) in 2007 (PϽ.001 for trend). There was a small increase in the prevalence of life-threatening conditions (1.7% [95% CI, 1.2%-2.2%; 59 of 5237 visits] in 1998 and 2.0% [95% CI, 1.6%-2.5%; 142 of 6567 visits] in 2007; P=.04 for trend). There was no change in prevalence of visits during which patients were either admitted to the hospital (5.9% [95% CI, 4.9%-6.9%] in 1998 and 5.5% [95% CI, 4.7%-6.5%] in 2007; P=.50 for trend) or to an intensive care unit (0.62% [95% CI, 0.40%-1.00%] in 1998 and 0.80% [95% CI, 0.53%-1.21%] in 2007; P=.14 for trend). Visits during which CT or MRI was obtained lasted 126 minutes (95% CI, 123-131 minutes) longer than those for which CT or MRI was not obtained. Conclusion From 1998 to 2007, the prevalence of CT or MRI use during emergency department visits for injury-related conditions increased significantly, without an equal increase in the prevalence of life-threatening conditions.

The Frequency of Brain CT-Scan Findings in Patients with Scalp Lacerations Following Mild Traumatic Brain Injury; A Cross-Sectional Study

“…According to a 2012 report from the Institute of Medicine, an estimated $210 billion per year of unnecessary services constitute excessive healthcare costs that yield no benefits to patients [17]. Overuse of head CT scans contributes to this problem [18]. The point that should kept in mind that although the cost and radiation exposure are among the adverse effects of the performing brain CT scans in emergency departments for evaluation of the mild TBI, but the advantage of detecting intracranial pathology would be more important.…”

Emergency Physician Perceptions of Medically Unnecessary Advanced Diagnostic Imaging

“…56 We believe that the existing desire in modern U.S. health care, to minimize and even eliminate any diagnostic uncertainty, is a primary contributor to our current, resource-intensive approach. 5,32,57,58 While this professional culture may be well-intentioned, in the case of advanced imaging it has not only failed to improve patient outcomes, [11][12][13][14][15] but has also led to overdiagnosis Data are reported as number (%). EM = emergency medicine.…”

“…6 Within EM there is significant variation in test-ordering rates, [7][8][9][10] and there has been a tremendous increase in utilization of advanced imaging despite little evidence to suggest associated improvement in patient outcomes. [11][12][13][14][15] The etiology of this increase is likely multifactorial and may include malpractice fear, 16,17 desire for diagnostic certainty, 18 lack of or inconsistent clinical decision instruments, [18][19][20] poor adoption of such decision instruments, 21,22 inadequate training in evidenced-based medicine, 23,24 slow knowledge translation, 25 perverse financial incentives, 26 requests of consulting and referring physicians, 27,28 and increased practice intensity and overall complexity of emergency care. 28,29 Regardless of etiology, there has been a strong push within EM to counter this behavior to provide high-value, costconscious care.…”

The Think A-Head campaign: an introduction to ImageGently 2.0

“…CT is used frequently to diagnose the child's condition and can be extremely helpful [16][17][18][19][20][21]. Head CT is in fact is the most common CT examination performed in children [22,23], accounting for 5-11% of examinations performed across all ages [22][23][24][25][26].…”