Chest and abdominopelvic CT scans rose among commercially insured patients for trauma-related ED visits between 2011 and 2018.

The largest gains were seen for single-encounter thoracabdominopelvic CT exams, which increased from 3.4 to 9.8 (1.16 per year) per 1,000 trauma-related ED encounters; and for minor injuries, which went from 1.1 to 4.6 (1.18).

This has raised concerns about higher costs and the detection of incidental findings. “Further investigation is warranted to explore the potential benefit of single-encounter thoracabdominopelvic CT examinations in patients with minor injuries, as well as strategies to optimize order appropriateness,” wrote first author Dr. Ninad Salastekar, from the department of radiology and imaging sciences at Emory University School of Medicine, in a statement.
Salastekar and his team studied trauma-related ED encounters recorded in national claims that they extracted from the IBM MarketScan Commercial Database. ED encounters were organized using the Injury Severity Score (minor, intermediate, major) through the International Classification of Diseases codes. They assessed chest CT, abdominopelvic CT and single-encounter thoracoabdominopelvic CT.

Intermediate and major injury CT scans also rose, from 6.4 to 16.4 (1.16); and 99.6 to 179.9 (1.08), respectively.

The authors caution that because their study excluded the majority of Medicare- or Medicaid-eligible individuals and entirely uninsured patients, “the findings may not generalize to such populations.”

The study was published in the American Journal of Roentgenology (AJR).

Salastekar did not respond to HCB News for comment.

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