Effect of the COVID-19 pandemic on CT scans ordered from the emergency department for abdominal complaints

Abstract

Purpose: The COVID-19 pandemic has affected healthcare systems and patients alike across the USA. We seek to elucidate changes in abdominal imaging ordered from the emergency department (ED) in a healthcare system undergoing non-surge conditions in April 2020 compared to April 2019.

Methods: We performed a retrospective, observational study comparing patients undergoing CT scans of the abdomen and pelvis ordered from the ED in April 2020 vs. April 2019 at a single healthcare center. Via review of the radiology report and electronic medical record, we determined the positive or negative status of these scans. We evaluated percentages of positive CT scans and differences in outcomes, including admission rates, interventions, and mortality.

Results: Comparing 2020 to 2019, there was a 31.6% decrease in the number of CT scans performed from the ED. We found a higher percentage of positive CT findings, 58.2% vs. 50.8% (p = 0.025), and increased admission rates, 40.8% vs. 34.1% (p = 0.036). Differences were found in rates of appendicitis, colitis, and cholangitis. No difference was found in ICU admissions, interventions, or in-hospital mortality.

Conclusion: During the COVID-19 pandemic in a region undergoing non-surge conditions, we found increased rates of positive CT scans performed from the ED for abdominal complaints with an increased percentage of hospital admissions compared to a control year. No differences in ICU admissions or rates of procedural intervention were found to suggest higher acuity of pathology on presentation. Our findings suggest appropriately decreased healthcare utilization in our study period, driven by pre-hospital patient self-selection.

Keywords: Abdominal pain; COVID-19; Computed tomography; Emergency department; Healthcare utilization.

Fig. 1

Two examples of the CT finding of “urinary bladder wall thickening”. a Axial CT images of the urinary bladder of a 27-year-old female patient who presented with flank pain. This scan was designated positive for the diagnosis of cystitis. b Axial CT images of the urinary bladder of a 68-year-old male patient who presented with right upper quadrant pain. This scan was designated negative for the diagnosis of cystitis

Fig. 2

A comparison of total visits to the emergency department in 2020 vs. 2019 (evaluated using the left axis), and a comparison of total CT scans performed in 2020 vs. 2019 with a ratio of positive to negative CT scan results (evaluated using the right axis)