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MRI, CT Scans for ER Patients Triple Over Decade
Date:10/5/2010

By Steven Reinberg
HealthDay Reporter

TUESDAY, Oct. 5 (HealthDay News) -- The use of CT and MRI scans for injury-related emergency room visits in the United States has tripled since 1998, new research finds.

"There has been a dramatic increase in the likelihood of getting a CT or MRI scan during visits to emergency departments for injury-related conditions without a corresponding increase in the likelihood of diagnosing life-threatening injuries during those visits," said lead researcher Dr. Frederick Kofi Korley, an assistant professor of emergency medicine at Johns Hopkins University in Baltimore.

"Emergency departments in the United States are excellent at rapidly diagnosing and treating life-threatening illnesses, however, we need to better understand how to provide the same level of care in a cost-effective way," he added.

A CT scan can cost anywhere from $270 to $4,800, depending on the body area scanned and hospital location, according to comparecatscancost.com. Likewise, an MRI goes for between $400 and $3,500, according to comparemricosts.com.

But besides raising health-care costs, scanning increases radiation exposure and prolongs stays in the ER, according to background information in the study, which is published in the Oct. 6 issue of the Journal of the American Medical Association.

To assess ER use of MRIs and CTs around the country, Korley's group used data from the National Hospital Ambulatory Medical Care Survey.

Of 324,569 emergency department visits between 1998 and 2007, 20 percent were injury-related, the researchers found.

Of 5,237 sample injury-related visits in 1998, 6 percent of the patients received an MRI or CT. By 2007, 15 percent of 6,567 patients sampled had scans, Korley's team found. CT scans accounted for most of the increase in imaging, they said.

Whether this growing reliance on technology improves outcomes is questionable.

In 1998, 1.7 percent of the scans revealed a life-threatening condition, such as spine fracture in the neck, skull fracture or bleeding of the brain, liver or spleen. In 2007, the researchers said 2 percent of scanned patients had any of these conditions, the researchers say.

Moreover, scans increased the length of time patients spent in the emergency department by 126 minutes.

More scans did not significantly increase hospital admissions -- 5.9 percent in 1998 vs. 5.5 percent in 2007. Admissions to intensive care units also remained stable -- 0.62 percent in 1998 and 0.80 percent in 2007.

Patients 60 years or older were more likely to receive CT or MRI scans than patients aged 18 to 45, who in turn were more likely to get imaging than patients 18 years and younger, the researchers found.

One expert, Dr. Raul N. Uppot, an assistant professor at Harvard Medical School, said the findings are flawed.

"What that the authors completely ignored, and surprisingly do not even address in their conclusion, is the impact of a negative medical imaging study," said Uppot, director of the Abdominal Imaging Fellowship Division at Massachusetts General Hospital in Boston.

Being able to tell patients that they definitively do not have an intracranial hemorrhage, for example, is invaluable, he said.

"The technological ability to do this in 2010 assures the ER physician that he or she has made a correct diagnosis, reduces the wait time and uncertainty anxiety for the patient, and reduces health-care costs," Uppot said.

But, Dr. Levon Nazarian, a professor of radiology and vice chairman for education at Thomas Jefferson University Hospital in Philadelphia, suspects other motives lie behind the growing use of scans.

For one thing, ER doctors are under pressure to get patients discharged as quickly as possible, he said. By ordering an imaging test, doctors think they can get a quicker diagnosis and move the patient out of the emergency department faster, he said.

Another factor, one which he said is key, is increased fear of lawsuits. "Doctors will say, 'I need this test for my own peace of mind. If I don't do this test I may get sued,'" he added.

More information

For more information on scans, visit the U.S. National Library of Medicine.

SOURCES: Frederick Kofi Korley, M.D., assistant professor, emergency medicine, Johns Hopkins University, Baltimore; Raul N. Uppot, M.D., assistant professor, Harvard Medical School, director, Abdominal Imaging Fellowship Division of Abdominal Imaging & Intervention Department of Radiology, Massachusetts General Hospital, Boston; Levon Nazarian, M.D., professor, radiology, and vice chairman, education, Thomas Jefferson University Hospital, Philadelphia; Oct. 6, 2010, Journal of the American Medical Association


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