Abdominal imaging utilization in the emergency department: trends over two decadesReport as inadecuate




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International Journal of Emergency Medicine

, 4:19

First Online: 27 April 2011Received: 13 November 2010Accepted: 27 April 2011

Abstract

BackgroundTo assess patterns of use of abdominal imaging in the emergency department ED from 1990 to 2009.

MethodsWe retrospectively reviewed data on adult ED patients treated between 1990 and 2009 at our university-affiliated quaternary care institution. Examinations were coded by abdominal imaging modality: x-ray, sonography, CT, or MRI. Proportional costs for each imaging modality were evaluated using relative value units RVUs. Chi-square tests were used to assess for significant trends.

ResultsThe intensity of abdominal imaging per 1,000 ED visits increased 19.3% from 1990-2009 p = 0.0050. The number of abdominal CT scans per 1,000 ED visits increased 17.5-fold p < 0.0001. Similarly, the number of abdominal MRIs per 1,000 ED visits increased from 0 to 1.0 p < 0.0001, and the number of abdominal sonographs per 1,000 ED visits increased 51.6% p = 0.0198. However, the number of x-ray examinations per 1,000 ED visits decreased 81.6% p < 0.0001. Abdominal imaging RVUs per 1,000 ED visits increased 2.7-fold p < 0.0001, due primarily to CT imaging, which accounted for 14% of RVUs in 1990 and 76% of RVUs in 2009.

ConclusionsThe intensity of abdominal imaging examinations per 1,000 ED visits and the number of abdominal imaging RVUs increased significantly over a 20-year period. CT replaced x-ray as the most common abdominal imaging modality for evaluation of ED patients. In light of these increasing costs as well as the increased radiation exposure of CT, clinical decision rules and computerized decision support may be needed to ensure appropriate utilization of abdominal CT in the ED.

Electronic supplementary materialThe online version of this article doi:10.1186-1865-1380-4-19 contains supplementary material, which is available to authorized users.

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Author: Ali S Raja - Koenraad J Mortele - Richard Hanson - Aaron D Sodickson - Richard Zane - Ramin Khorasani

Source: https://link.springer.com/article/10.1186/1865-1380-4-19







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