CT in Non-serious Trauma Growing

January 26, 2016

Use of CT imaging among emergency department patients with non-serious injuries has increased significantly.

Use of CT almost doubled among patients with non-serious injuries who presented to emergency departments (EDs) in California, according to a study published in the Journal of Surgical Research.

Researchers from the University of California in San Francisco (UCSF), and Stanford University in California, evaluated the frequency of CT imaging in patients who presented to the ED with minor traumas, such as fractures and neck strains, most often sustained by motor vehicle accidents or falls. Records from 2005 to 2013 were obtained for the retrospective analysis from the California Office of Statewide Health Planning and Development Emergency Department and Ambulatory Surgery Data.

Inclusion into the study required a traumatic ECODE diagnosis and an injury severity score of less than nine, and discharge home. A total of 8,535,831 adult patients were identified. The results showed that 5.9% of these patients underwent at least one CT scan during their ED visit. The proportion of patients with at least one CT scan during such an ED visit increased from 3.51% in 2005 to 7.17% in 2013, the researchers found. Adjusted predictors for CT included:

Being between the ages of 18 and 24

Being older than 45 years

Medicare and self-pay patients

Fall injuries

Motor vehicle collision injuries

Patients seen at level I/II trauma centers[[{"type":"media","view_mode":"media_crop","fid":"45337","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_784011481662","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5181","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 255px; width: 170px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Renee Hsia, MD, MSc","typeof":"foaf:Image"}}]]

"The reasons for this increase are multifactorial," senior author Renee Hsia, MD, a professor of medicine and health policy at UCSF, said in a release. "They range from defensive medicine practices, the superior diagnostic accuracy of CT scans compared with x-rays, to their increased availability and convenience in emergency departments, and the demand to expedite discharge of patients."

"The message for both patients and physicians is that there are long-term risks associated with radiation exposure and there may be situations where imaging is not definitively warranted or beneficial," Hsia explained. "We can't conclusively say which cases should not involve imaging, since every patient and every circumstance is different, but given that it is getting easier and easier to get CT scans, we need to be cautious in weighing their risks and benefits."