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Emergency department CT, MRI use increased threefold in 10-year period

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As CT scans gradually improved in quality compared to radiographs, their use became significantly more prevalent for diagnosing injury-related visits to U.S. emergency departments from 1999 to 2007, according to a study in the Journal of the American Medical Association (JAMA).

However, study investigators found that the frequency in the diagnosis of certain life-threatening trauma-related conditions requiring detailed imaging, such as cervical spine and skull fractures, did not proportionately increase during that time period, according to a Johns Hopkins press release.

For their study, Frederick Kofi Korley, MD, of Johns Hopkins University in Baltimore, and colleagues used the National Hospital Ambulatory Medical Care Survey to examine national trends in the use of advanced radiology techniques during emergency department (ED) visits from 1998 to 2007. They sampled 324,569 ED visits and found that 65,376, or 20%, of them were due to injury-related conditions.

Rise in CT use

Among the 5,237 injury-related ER visits sampled for 1998, 257 patients received CT or MRI (6%) compared to 981 patients (15%) among the 6,567 visits in 2007. According to the JAMA release, the investigators noted that the increase in CT use accounted for most of the overall increased CT or MRI use.

The authors wrote, “Some factors that may have contributed to this significant increase in CT use are: the superiority of CT scans over X-rays for diagnosing conditions such as cervical spine fractures; the routine use of whole-body scanning for patients treated in some trauma centers; the increased availability of CT scanners; the proximity of CT scanners to the patient care areas of most emergency departments; the speed of new-generation CT scanners leading to a decrease in the need to sedate pediatric patients; and concern about malpractice lawsuits for a missed diagnosis.”

Life-threatening conditions

Injury-related conditions are common reasons for U.S. ED visits, but since 70% of them occur in those younger than 45 years, knowing whether use of these diagnostic tools has increased is important since younger people are at greatest risk for possible long-term effects from radiation exposure, the authors wrote.

The investigators also found that life-threatening conditions accounted for 1.7% of sampled ER visits in 1998 whereas, in 2007, they accounted for 2.0% of visits. According to the release, Korley and colleagues noted no change in injury-related hospital and intensive care unit visits during the 10-year period studied.

Reference:

Korley FK, Pham JC, Kirsch TD. Use of advanced radiology during visits to US emergency departments for injury-related conditions, 1998-2007. JAMA. 2010;304:1465-1471.

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