A recent study published in the Annals of Emergency Medicine on the rapid increase in CT scans being performed in Emergency Rooms (ER) paired with the decline in hospital admission rates between 1996 and 2007, got me thinking. During this time, the number of CT scans being performed increased by 330 percent, while the rate of those admitted following a CT scan decreased from 26 percent in 1996 to 12.1 percent in 2007. Does this mean that more patients are receiving unnecessary radiation exposure? Well… not necessarily.
The article points out a conflict about the use of CT in ER patients. Remember that practicing medicine in an ER is very different from a physician’s office. Patients are more acutely ill and ER congestion can be marked. Plus, time spent in the ER is very expensive.
In our study of patients presented to an ER with low to moderate risk chest pain, we found that a negative triple rule out CT resulted in shortening the stay by over 20 hours and cutting the cost of the ER encounter by 50%. Further, discharging a patient to home if their CT was negative was a safe practice.
Therefore, under the right circumstances, the use of CT in ER patients can be very effective. Our challenge is – through outcomes research – finding those right circumstances.
For more information on emergency medicine at UW, please see here.