Trends in computed tomography utilization and association with hospital outcomes in a Chinese emergency department.
BACKGROUND
Excessive use of computed tomography (CT) in emergency departments (EDs) has become a concern due to its expense and the potential risks associated with radiation exposure. Although studies have shown a steady increase in the number of CT scans requested by ED physicians in developed countries like the United States and Australia, few empirical data are available regarding China.


RESULTS
We retrospectively analyzed a database of ED visits to a tertiary Chinese hospital to examine trends in CT utilization and their association with ED outcomes between 2005 and 2008. A total of 197,512 ED visits were included in this study. CT utilization increased from 9.8% in 2005 to 13.9% in 2008 (P<.001 for trend). The ED length of stay for visits with CT utilization was 0.6 hour longer than those in which CT was not obtained. CT utilization increased the ED cost by an average $48.2. After adjustment for patients' demographics, arrival hours and clinical condition, CT utilization during ED visits was significantly associated with high ED cost (Odds Ratio [OR]: 21.70; 95% confidence interval [CI], 17.00-27.71), long ED length of stay (OR: 1.22; 95%CI, 1.12-1.34), and more likely to receive emergency operations (OR: 2.31; 95%CI, 1.94-2.76). However, there was no significant correlation between CT use and the possibility to be admitted to inpatient wards (OR: 0.82; 95%CI, 0.65-1.04). With respect to the time-related trends, CT utilization during ED visits in all study years was significantly associated with high ED cost and more likely to receive emergency operations.


CONCLUSIONS
CT utilization was associated with higher ED cost, longer ED length of stay and more likely to receive emergency operations, but did not correlate with a significant change in the admission rate.
Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Jian-Cang
JC
Zhou
San-Wei
SW
Zheng
Yun-Xian
YX
Yu
Keith
K
Rouleau
Wei-Liang
WL
Jiang
Chong-Wu
CW
Jin
Dao-Yang
DY
Zhou
Kong-Han
KH
Pan
Yun-Song
YS
Yu
D000293:Adolescent; D000328:Adult; D000368:Aged; D002681:China; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data* / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data* / Q000639:trends*; D016896:Treatment Outcome; D055815:Young Adult