ED patients are undergoing CT scans about four times more frequently than patients in the mid-1990s, according to a study
in the Annals of Emergency Medicine
For the study, University of Michigan Health System
researchers and colleagues examined data from the National Hospital Ambulatory Medical Care Survey for 368,680 ED visits at 601 hospitals from 1996 to 2007. The study found that the use of CTs in the ED jumped from 3.2% of all admissions in 1996 to 13.9% of all admissions in 2007.
The largest jump in CT scans was for older patients, the study found. In 1996, about 9.1% of patients over age 79 had a scan in the ED, compared to about 29.1% in 2007. CT scan rates increased most for abdominal pain, chest pain, flank pain, and shortness of breath, according to the findings. Meanwhile, the hospitalization rate for patients who underwent a CT scan fell from 26% in 1996 to about 12% in 2007, while the overall hospitalization rate for ED patients rose from 11% to 13% during that time period.
The researchers say several factors may have contributed to the growth in CT scan use in EDs, including greater diagnostic accuracy, reimbursement updates, and defensive medicine. The American College of Emergency Physicians
defended the increase, noting that the test has helped reduce hospitalizations, Kaiser Health News
' "Capsules" reports.
In an accompanying editorial
, a University of Florida Health Science Center
physician says reducing CT scan use may be difficult because imaging "is not an entirely objective question that can be neatly resolved by empirical data and formal analysis." Instead, he argues that it is "a tangled, socially constructed issue involving competing views of risk, benefit, and obligation, and the elusive question of how much certainty we must have" (CMIO
, 8/10; Nafziger, DOTmed News
, 8/10; Galewitz, "Capsules