Dramatic increase in CT, MRI scans for ER patients

The use of CT scans or MRIs in emergency departments nearly tripled over a 10-year period without a corresponding change in the prevalence of life-threatening conditions among ER patients, according to a study published in the Journal of the American Medical Association.

Between 1998 and 2007, the share of injury-related ER patients who received MRI or CT scans rose to 15 percent up from 6 percent, based on a nationwide sample of more than 300,000 ED visits from the Center for Disease Control and Prevention's National Hospital Ambulatory Medical Care Survey.

Dr. Frederick Korley, lead author and an assistant professor of emergency medicine at Johns Hopkins University, characterized the change as "a really significant increase," Reuters reports. "It implies there is a potential amount of overuse or use that is not directly yielding any meaningful clinical results," he said.

Although researchers did not say the use of advanced imaging was unwarranted, MedPage Today reports, they did call for more investigation into why CT or MRIs are increasingly used in EDs "to optimize the risk-benefit balance of advanced radiology use."

Besides raising healthcare costs with scans that can cost several hundred to a few thousand dollars, the possibly unnecessary radiation exposure and longer ER stays (an average of two hours longer) are issues worth considering, according to the authors.

What's behind the growing use of scans?

The pressure to get patients discharged as quickly as possible might drive the decision to order an imaging test, Dr. Levon Nazarian, a professor of radiology at Thomas Jefferson University Hospital in Philadelphia, told HealthDay News. He added that fear of lawsuits due to missed diagnosis is another factor.

Another expert told HealthDay that the authors failed to address the significance of a negative scan. The ability to rule out an intracranial hemorrhage, for example, is invaluable, said Dr. Raul Uppot, director of the Abdominal Imaging Fellowship Division at Massachusetts General Hospital.

To learn more:
- read the JAMA abstract
- here is the Reuters article
- read the HealthDay News article
- see the MedPage Today story