MSCT brings ER costs down

Hospital costs were expected to increase as CT supplanted radiography in the emergency room, but data from Massachusetts General Hospital show that CT in the ER cuts costs associated with evaluating facial trauma and decreases the number of scans needed per exam.

MGH investigators reviewed records of facial trauma evaluations performed with CT at their institution between 1992 and 2002. They found the average number of exams per patient declined from 1.23 to 1.03 in the 10-year span. Of the 890 patients examined in 1992, 671 underwent radiography, 153 had CT, and 66 had both. In 2002, those numbers were almost reversed and were lower overall: of 828 patients, 584 underwent CT, 228 had x-ray, and 16 had both. The estimated overall savings related to the imaging trade-off was $29,601 (AJR 2004;183[3]:751-754).

"The fact that the total number of imaging exams went down suggests that CT is more efficient in evaluating facial trauma and should allay fears that costs will skyrocket with new methods," said coauthor Dr. James H. Thrall, radiologist-in-chief at MGH.

Technological updates may have influenced the results. The 1992 CT protocol included two unenhanced acquisitions, hard-copy interpretation, and no PACS. The 2002 CT protocol included multislice scanning, 3D reconstruction, and soft-copy review on a PACS workstation for both CT and x-ray imaging.

CT gets the right answer faster than conventional x-ray imaging in many applications and has supplemented the physical exam, which has always been problematic in many situations, Thrall said.