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CT/MRI Use In ED Injury Cases Skyrockets

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Nobody would probably be surprised to learn that from 1998 to 2007, emergency departments increased their use of CT and MRI to diagnose injuries. But by as much as three-fold?

That’s the conclusion of a new study published today in the Journal of the American Medical Association. The researchers looked at data from the federal National Hospital Ambulatory Medical Care Survey.

They found that in 1998, advanced imaging occurred during 5 percent to 7 percent of injury-related ED visits. In 2007, the estimate was 14 percent to 17 percent. Lead author Frederick Kofi Korley, MD, an emergency physician and assistant professor at Johns Hopkins Medical in Baltimore, told HealthImaging.com:

We were quite surprised by the finding, particularly by the magnitude of the increase. It’s a pretty astronomical increase.

The study says that the greater usage of CT and MRI was associated with a small increase in the diagnosis of life-threatening conditions (from about 1.7 percent to about 2.0 percent), but it found no increase in admittance to a hospital or intensive-care unit. One other thing definitely increased: use of CT or MRI added two hours to the average ED visit.

CT and MRI scans are, of course, more costly than conventional X-rays. And CT delivers an increased radiation dose. “The carcinogenic effects of exposure to CT are especially important in patients presenting with injury-related conditions because they tend to be younger and receive multiple CTs,” the study’s authors wrote.

The researchers speculated: “Some factors that may have contributed to this significant increase in CT use are the superiority of CT scans over X-rays for diagnosing conditions such as cervical spine fractures, the routine use of whole-body scanning for patients treated in some trauma centers, the increased availability of CT scanners, the proximity of CT scanners to the patient care areas of most emergency departments, the speed of new-generation CT scanners, leading to a decrease in the need to sedate pediatric patients, and concern about malpractice lawsuits for a missed diagnosis.”

Dr. Korley did tell HealthImaging.com: “We’re just beginning to understand the problem. We don’t know if it represents overuse or not.” For example, he said, some patients who might otherwise have been admitted to the hospital might end up not being admitted after a CT scan provides a precise picture of their injuries. In that scenario, a CT scan would actually reduce health-care costs.

And, frankly, it’s easy to see how an ED doctor might use all the tools at his or her disposal rather than pause to undertake a cost-benefit analysis. “In the ED,” Dr. Korley said, “our first focus is on saving lives.”

Related seminar: Emergency Radiology

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