The overwhelming majority (93.8 percent) of patients undergoing computed tomography (CT) of the abdomen and pelvis (CTAP) in the emergency department (ED) setting are classified as clinically complex, according to a study in the June issue of the Journal of the American College of Radiology. Clinically complex is used to describe patients who are, based on documentation of their ED physician, much sicker than others.
Increasing clinical evidence has validated the utility of CTAP in a variety of clinical settings. As a result, the utilization of CTAP has increased in recent years, in both the ED and a variety of other settings, resulting in questions regarding the appropriateness of its utilization.
"Understanding the complexity of patient encounters in which advanced medical imaging services are frequently delivered might be useful in aiding payers and policymakers in explaining the growth of advanced imaging services over the past decade and determining the context in which these examinations are appropriately being used," said Richard Duszak, Jr., MD, co-author of the study.
Using the CMS five percent Medicare files for 2007, ED visits for Medicare fee-for-service beneficiaries were identified. Contemporaneous ED physician evaluation and management codes were used as the basis for patient complexity categorization. Encounters in which CTAP was performed on the same date of service were identified, and variables affecting the utilization of CTAP were analyzed.
Results showed that of 1,081,000 ED encounters, 306, 401 (28.3 percent) were of lower complexity and 774, 599 (71.7 percent) were of higher complexity. CT of the abdomen and pelvis was performed in 65,273 of all encounters (6.0 percent), corresponding to 4,069 (1.3 percent) of lower complexity and 61,204 (7.9 percent) of higher complexity encounters. Of the 65,273 encounters associated with CTAP, 61,204 (93.8 percent) were of higher complexity.
"The utilization of advanced medical imaging in the ED setting serves many valuable roles. CT of the abdomen and pelvis can facilitate patient triage, decrease ED patient waiting times, decrease hospital lengths of stay and reduce the need for exploratory surgery. These outcomes would favor a preferential role for CTAP in sicker and more complex patients, and our results support that belief," said Duszak.
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