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.

Effect of the COVID-19 pandemic on emergency department utilization of computed tomography scans of appendicitis and diverticulitis

“…However, they found that the number of scans conducted quickly rebounded back to the historical amount in the months of June and July [ 22 ]. This has been a consistent finding in multiple other studies [ 18 , 19 , 33 – 35 ], which have echoed substantial decreases in the amount of CT scans ordered early in the pandemic.…”

“…Similarly, examining CT scans of the abdomen and pelvis for all abdominal complaints from two hospitals in Utah, Griffith et al (2021) reported a 31.6% decrease in CT abdomen and pelvis scans in April 2020 compared to April 2019, while having a higher positivity rate in 2020. However, the only abdominal complaints that were significantly different in 2020 for positivity rate were appendicitis, cholangitis, and colitis, whereas the other 14 abdominal complaints showed no difference between the two timepoints [ 18 ].…”

“…Therefore, the predicted number represents patients that would require a CT abdominal scan if 2020 were a “normal” year, which our pre-lockdown data shows that before COVID-19 it was trending as equivalent. Other papers chose to present their data using different methods, such as the total percent change in patients seen and CT abdominal scans ordered [ 18 , 19 , 22 , 33 – 35 ]. Consequently, the relative increases in the amount of CT abdominal scans shown in our study might have been equivalents at other centers if their data were shown as compared to normalized trends.…”

Impact of the COVID-19 pandemic on radiology department emergency ultrasound utilization

“…This decrease is less than the change in volume of ED ultrasounds performed by the radiology department, which neared a 60% decline. The relative decrease in utilization of radiology department ultrasound during the pandemic was certainly accentuated by the change in distribution of clinical presentations to the ED [28] and in practitioner decisions to defer imaging of lower acuity patients [14,29]. Another factor leading to our decreased ED imaging utilization in 2020 can be understood by the study population we serve.…”

Acute appendicitis–advances and controversies

“…However, the converse has also been reported where no differences in complications or severity in AA presentation were seen in other regions. In a retrospective study by Griffith et al [ 132 ] comparing 2020 and 2019 AA admissions, there was an increased admission rate (40.8% vs 34.1%, P = 0.036)[ 132 ]. Kohler et al [ 133 ] revealed in a population-based study in Germany that there was no difference in the number of perforated AA diagnosed during the pandemic or pre-pandemic[ 133 ].…”