Raja et al. International Journal of Emergency Medicine 2011, 4:19 ORIGINAL RESEARCH Open Access Abdominal imaging utilization in the emergency department: trends over two decades Ali S Raja1,2,4*, Koenraad J Mortele1,3,4, Richard Hanson1,3, Aaron D Sodickson1,3,4, Richard Zane1,2,4 and Ramin Khorasani1,3,4 Abstract Background: To assess patterns of use of abdominal imaging in the emergency department (ED) from 1990 to 2009. Methods: We retrospectively reviewed data on adult ED patients treated between 1990 and 2009 at our universityaffiliated quaternary care institution. Examinations were coded by abdominal imaging modality: x-ray, sonography, CT, or MRI. Proportional costs for each imaging modality were evaluated using relative value units (RVUs) | Raja et al. International Journal of Emergency Medicine 2011 4 19 http content 4 1 19 o International Journal of Emergency Medicine a SpringerOpen Journal ORIGINAL RESEARCH Open Access Abdominal imaging utilization in the emergency department trends over two decades Ali S Raja1 2 4 Koenraad J Mortele1 3 4 Richard Hanson1 3 Aaron D Sodickson1 3 4 Richard Zane1 2 4 and Ramin Khorasani1 3 4 Abstract Background To assess patterns of use of abdominal imaging in the emergency department ED from 1990 to 2009. Methods We retrospectively reviewed data on adult ED patients treated between 1990 and 2009 at our university-affiliated quaternary care institution. Examinations were coded by abdominal imaging modality x-ray sonography CT or MRI. Proportional costs for each imaging modality were evaluated using relative value units RVUs . Chisquare tests were used to assess for significant trends. Results The intensity of abdominal imaging per 1 000 ED visits increased from 1990-2009 p . The number of abdominal CT scans per 1 000 ED visits increased p . Similarly the number of abdominal MRIs per 1 000 ED visits increased from 0 to p and the number of abdominal sonographs per 1 000 ED visits increased p . However the number of x-ray examinations per 1 000 ED visits decreased p . Abdominal imaging RVUs per 1 000 ED visits increased p due primarily to CT imaging which accounted for 14 of RVUs in 1990 and 76 of RVUs in 2009. Conclusions The intensity of abdominal imaging examinations per 1 000 ED visits and the number of abdominal imaging RVUs increased significantly over a 20-year period. CT replaced x-ray as the most common abdominal imaging modality for evaluation of ED patients. In light of these increasing costs as well as the increased radiation exposure of CT clinical decision rules and computerized decision support may be needed to ensure appropriate utilization of abdominal CT in the
