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. 2017 Aug;18(5):835-845.
doi: 10.5811/westjem.2017.5.34152. Epub 2017 Jul 19.

Increased Computed Tomography Utilization in the Emergency Department and Its Association with Hospital Admission

M Fernanda Bellolio  1   2   3 , Herbert C Heien  2 , Lindsey R Sangaralingham  2 , Molly M Jeffery  2   3 , Ronna L Campbell  1 , Daniel Cabrera  1 , Nilay D Shah  2   3   4 , Erik P Hess  1   3
Affiliations

Increased Computed Tomography Utilization in the Emergency Department and Its Association with Hospital Admission

M Fernanda Bellolio et al. West J Emerg Med. 2017 Aug.

Abstract

Introduction: Our goal was to investigate trends in computed tomography (CT) utilization in emergency departments (EDs) and its association with hospitalization.

Methods: We conducted an analysis of an administrative claims database of U.S. privately insured and Medicare Advantage enrollees. We identified ED visits from 2005 through 2013 and assessed for CT use, associated factors, and hospitalization after CT, along with patient demographics. We used both descriptive methods and regression models adjusted for year, age, sex, race, geographic region, and Hwang comorbidity score to explore associations among CT use, year, demographic characteristics, and hospitalization.

Results: We identified 33,144,233 ED visits; 5,901,603 (17.8%) involved CT. Over time, CT use during ED visits increased 59.9%. CT use increased in all age groups but decreased in children since 2010. In propensity-matching analysis, odds of hospitalization increased with age, comorbidities, male sex, and CT use (odds ratio, 2.38). Odds of hospitalization over time decreased more quickly for patients with CT.

Conclusion: CT utilization in the ED has increased significantly from 2005 through 2013. For children, CT use after 2010 decreased, indicating caution about CT use. Male sex, older age, and higher number of comorbidities were predictors of CT in the ED. Over time, odds of hospitalization decreased more quickly for patients with CT.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. This publication and related research project was supported by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of Mayo Clinic.

Figures

Figure 1
Figure 1
Rates of admission to the hospital by patient comorbidities (Hwang comorbidity score). Age and CT performed in the emergency department among the matched cohort.
Figure 2
Figure 2
Odds of admission to the hospital associated with CT performed in the emergency department over time.
See this image and copyright information in PMC

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