Use of CT Scans on the Rise in Emergency Departments

Doug Desjardins, February 2, 2016

Factors driving physicians to order the imaging studies range from defensive medicine practices, their superior diagnostic accuracy compared with X-rays, and the demand to expedite the discharge of patients, says one researcher.

This article originally appeared in California Healthfax.

The use of CT scans in hospital emergency departments for non-serious injuries like fractures and sprains has nearly doubled over the last 10 years, according to a new study.

The study from researchers at UC San Francisco found that 7.17% of patients treated for minor injuries at EDs in California underwent at least one CT scan in 2013 compared to just 3.51% of patients in 2005. The study published in the January 19 edition of the Journal of Surgical Research looked at more than 8 million patient visits to 348 California hospitals using data compiled by the Office of Statewide Health Planning and Development (OSHPD).

"The reasons for this increase are multi-factorial," said the study's senior author Renee Hsia, MD, a professor of emergency medicine and health policy at UC San Francisco. "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 the discharge of patients."

The study also noted that, while CT scans can help clinicians and physicians pinpoint the source of potentially life-threatening conditions, they also expose patients to "ionizing radiation that is associated with an increased risk of cancer." The report cited a 2009 study from the U.S. Food and Drug Administration that suggested a "single CT scan may be associated with a fatal cancer in one in 2,000 patients."

The UCSF study noted that CT scans were more likely to be ordered in emergency departments that operate trauma centers. It found that 39% of all CT scans in the study were ordered at Level I and Level II trauma centers.

"This may reflect an underlying work culture centered around the management of severely injured patients, guided by standard trauma CT protocols, and also the fact that level I and II trauma centers see sicker patients," the study stated. Hsia said the potential side effects from CT scan radiation is something patients should consider when being treated at an ED.

"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 definitely not warranted or beneficial," said Hsia. "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 to get CT scans, we need to be cautious in weighing their risks and benefits."

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