Utilization of chest CT for injured patients during visits to U.S. emergency departments: 2012-2015

Introduction Increased use of computed tomography (CT) during injury-related Emergency Department (ED) visits has been reported, despite increased awareness of CT radiation exposure risks. We investigated national trends in the use of chest CT during injury-related ED visits between 2012 and 2015. Methods Analyzing injury-related ED visits from the 2012–2015 United States (U.S.) National Hospital Ambulatory Medical Care Survey (NHAMCS), we determined the percentage of visits that had a chest CT and the diagnostic yield of these chest CTs for clinically-significant findings. We used survey-weighted multivariable logistic regression to determine which patient and visit characteristics were associated with chest CT use. Results Injury-related visits accounted for 30% of the 135 million yearly ED visits represented in NHAMCS. Of these visits, 817,480 (2%) received a chest CT over the study period. The diagnostic yield was 3.88%. Chest CT utilization did not change significantly from a rate of 1.73% in 2012 to a rate of 2.31% in 2015 (p = 0.14). Multivariate logistic regression demonstrated increased odds of chest CT for patients seen by residents versus by attendings (adjusted odds ratio [AOR] 2.08, 95% confidence interval [CI] 1.41–3.08). Patients aged 18–59 and 60+ had higher AORs (5.75, CI 3.44–9.61 and 9.81, CI 5.90–16.33, respectively) than those Conclusions Overall chest CT utilization showed an increased trend from 2012 to 2015, but the results were not statistically significant.