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. METHODS AND FINDINGS: 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. CONCLUSION: 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.