Use of emergency department imaging in patients with minor trauma

Abstract

Background

Advanced radiographic studies have detrimental risks, yet the prevalence of CT utilization in patients with minor trauma presenting to the emergency department (ED) has never been fully evaluated. Our objective was to evaluate the frequency of CT imaging in patients presenting to the ED for minor trauma.

Materials and methods

A retrospective analysis of the California Office of Statewide Health Planning and Development Emergency Department and Ambulatory Surgery Data from 2005 to 2013 was performed. A total of 8,535,831 patients were identified using the following inclusion criteria: adult patients (age ≥18 y); with a traumatic ECODE diagnosis and injury severity score <9; and discharge to home. The primary study outcome measurement was the prevalence of CT imaging for each year in the study period. We performed univariate and multivariate analysis to evaluate clinical and hospital-level factors related to CT use in this population. We also performed a trend analysis using Poisson logistic regression to assess the trend of imaging scans over the study period.

Results

Of the study population, 5.9% received at least one CT study during their ED visit. The proportion of patients with at least one CT scan increased from 3.51% in 2005 to 7.17% in 2013 (P < 0.005). Adjusted predictors for CT included age 18–24 y or >45 y (P < 0.005), Medicare and self-pay patients (P < 0.005), fall injuries (P < 0.005), motor vehicle collision injuries (P < 0.005), and patients seen at level I/II trauma centers (P = 0.005).

Conclusions

Even after clinical and demographic predictors were adjusted for, there was a 1.97-fold increase in CT among minor trauma patients from 2005-2013.

Introduction

Over the past decade, there has been a dramatic rise in the use of imaging, specifically computed tomography (CT) in emergency departments in the United States [1], [2]. Imaging plays an important role in the diagnosis and treatment of injured patients. Current evidence suggests that early use of whole-body CT scanning may decrease mortality, reduce time spent in the emergency department, lead to more accurate diagnoses, and result in faster diagnosis in patients presenting with major trauma [3], [4], [5], [6], [7]. However, few publications have assessed the benefits of imaging for patients with minor trauma, especially for advanced imaging such as CT. This is important given the increased radiation exposure and associated cancer susceptibility, as well as high costs [8], [9], [10], [11], [12], [13].

Recent awareness of these issues has resulted in campaigns directed at reducing potential overuse of imaging studies [14], [15], [16]. And although numerous clinical decision making tools have been created to guide judicious ordering of CT imaging, studies indicate a lack of adherence to these prediction rules. [17], [18], [19], [20].

Identifying the prevalence and trend in utilization in patients with minor or no injuries is important, and no prior studies have fully evaluated these patients except studies focusing on minor head injuries [21]. The purpose of our study was to evaluate the frequency of CT imaging for adults with minor trauma presenting to the ED who ultimately did not require admission. We hypothesized that the utilization of imaging has increased even for patients with minor trauma.