Trends of CT utilisation in an emergency department in Taiwan: a 5-year retrospective study

Abstract

ObjectivesTo investigate the association between the trends of CT utilisation in an emergency department (ED) and changes in clinical imaging practice and patients' disposition.SettingA hospital-based retrospective observational study of a public 1520-bed referral medical centre in Taiwan.ParticipantsAdult ED visits (aged ≥18 years) during 2009–2013, with or without receiving CT, were enrolled as the study participants.Main outcome measuresFor all enrolled ED visits, we retrospectively analysed: (1) demographic characteristics, (2) triage categories, (3) whether CT was performed and the type of CT scan, (4) further ED disposition, (5) ED cost and (6) ED length of stay.ResultsIn all, 269 239 adult ED visits (148 613 male patients and 120 626 female patients) were collected during the 5-year study period, comprising 38 609 CT scans. CT utilisation increased from 11.10% in 2009 to 17.70% in 2013 (trend test, p<0.001). Four in 5 types of CT scan (head, chest, abdomen and miscellaneous) were increasingly utilised during the study period. Also, CT was increasingly ordered annually in all age groups. Although ED CT utilisation rates increased markedly, the annual ED visits did not actually increase. Moreover, the subsequent admission rate, after receiving ED CT, declined (59.9% in 2009 to 48.2% in 2013).ConclusionsED CT utilisation rates increased significantly during 2009–2013. Emergency physicians may be using CT for non-emergent studies in the ED. Further investigation is needed to determine whether increasing CT utilisation is efficient and cost-effective.

Computed Tomography: Return on Investment and Regional Disparity Factor Analysis

“…Recent studies suggest that if appropriate clinical criteria are followed, 20–40% of CT scans could be avoided (20–22). Similar to Japan, CT use has been increasing in other Asian countries too (23, 24). Hu et al (24) reported that CT utilization rates increased significantly between 2009 and 2013 in emergency departments.…”

“…Similar to Japan, CT use has been increasing in other Asian countries too (23, 24). Hu et al (24) reported that CT utilization rates increased significantly between 2009 and 2013 in emergency departments. They speculated that CT scans may be used for rapid screening to facilitate patients' disposition rather than to confirm diagnosis, given the stress of emergency department crowding and potential lawsuits.…”

Radiation Safety in Emergency Medicine: Balancing the Benefits and Risks

“…For urinary tract infections, the figure went up from 0 in 1996 to 48% of presentations in 2016 (13). A Taiwanese study found that although the use of CT had increased in emergency departments, the hospital admission of patients who underwent scans had decreased (14), indicating that the use of CT has largely been for non-emergency conditions and to “rule-out” a particular diagnosis.…”

Radiation doses with various body weights of phantoms in brain 128-slice MDCT examination

“…Chen et al stated that the annual CT examination frequency per 1000 population increased by an average of 8.1% per year from 1997 to 2008 [3]. Hu et al found that the annual frequency of CT scans increased from 11.1% in 2009 to 17.7% in 2013, and that the frequency increased for all age groups in Taiwan [4]. The number of CT examinations increased rapidly, with an average annual growth rate of 7.6%, and this trend was similar to those in other countries [5].…”