Emergency department CT use for cervical spine has increased

2017 01 23 10 15 18 149 Spine 400

The use of CT in the emergency department (ED) for cervical spine imaging has increased, according to a study published online August 2 in the Journal of the American College of Radiology.

The trend could be due to increases in CT imaging for minor imaging in patients with private insurance, wrote a team led by Dr. Akram Khaja of Emory University School of Medicine in Atlanta, GA.

Clinical practice guidelines intended to reduce unnecessary cervical spine imaging have yielded mixed results, according to the group. The team sought to assess ED cervical spine injury in patients with trauma using information from the IBM MarketScan Commercial Database between 2009 and 2018; the researchers identified ED trauma visits and any cervical spine imaging prompted by those visits. They also classified ED encounters by injury severity.

There were 11.3 million emergency department visits for trauma during the study time frame, the bulk of which (68.3%) were for minor injuries. Overall cervical spine imaging increased annually by 5.7%, with x-ray decreasing 2.7% annually and CT increasing 10.5% annually. In fact, the use of CT increased the most for minor injuries, the team found.

"Recent increases in cervical spine imaging in commercially insured patients with trauma seen in the emergency department have been largely related to increases in CT for patients with only minor injuries, in whom imaging utilization has been historically low," the group concluded. "Further study is necessary to assess appropriateness, implications on costs and population radiation dose, and factors influencing ordering decision-making."

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