The use of CT in the emergency departments (ED) has shown a "pronounced increase" -- more than 100% -- over the course of 10 years in the U.S., according to a study published September 30 in Radiology.
The finding could be due to the "evolving role of CT in ED care delivery," wrote authors Andrew Rosenkrantz, MD, and colleague Ryan Cummings, MD, both of NYU Langone Medical Center in New York City.
Previous studies have shown definitive growth in the use of imaging in the ED, which can "strain radiology practices given radiologist shortages and expectation of providing prompt interpretations on a 24-7 basis," Rosenkrantz and Cummings explained. As many of these previous studies concluded before the COVID pandemic, the pair sought to assess any recent changes to national ED imaging use.
Rosenkrantz and Cummings used data from the U.S. Centers for Medicare and Medicaid Services (CMS) Physician/Supplier Procedure Summary files from between 2013 to 2023 to track service counts for x-ray, ultrasound, and CT exams performed in the ED and billed by radiologists. They also culled annual counts of ED encounters and identified use of ED imaging per beneficiary.
The team reported the following:
Use of imaging in the ED, 2013 to 2023 | |||
Measure | 2013 | 2023 | Percent change |
| Overall ED encounters per 100 beneficiaries | 65% | 54.5% | -16.1% |
ED encounters involving use of imaging per 100 beneficiaries | |||
| CT | 28.7% | 67.1% | 133.5% |
| Ultrasound | 3.6% | 5.1% | 42.7% |
| X-ray | 57.4% | 68.5% | 19.2% |
In particular, brain, spine, and abdomen/pelvis CT exams increased over the time period.
Bar graph comparing CT scan modalities across 2013 and 2023.Graphic courtesy of the RSNA.
The increase in CT use in the ED is due to more imaging per encounter rather than more ED encounters per beneficiary, Rosenkrantz and Cummings noted, writing also that it was consistent across examination types, including CT angiography (CTA) exams.
The authors did acknowledge several limitations to their study, including "lack of information regarding the examinations' indications, appropriateness, and quality [and] lack of assessment of changes in downstream outcomes from ED imaging." In light of these, Rosenkrantz and Cummings urged further study "to better understand the drivers of the growth."
The complete work can be found here.
