COVID changes in CT use in the ED suggest path going forward

By Kate Madden Yee, staff writer

June 23, 2022 -- How did the COVID-19 pandemic affect the use of CT in the emergency department (ED) -- and will the crisis change the way ED physicians use CT going forward? Perhaps, a study published June 21 in Emergency Radiology suggests.

Although there may have been a decline in the absolute number of CT imaging exams performed during the acute phase of the pandemic -- due to studies being postponed or canceled -- there was an increase in CT exams in the ED as physicians grappled with diagnosing the disease, wrote a team led by Dr. Timothy Loftus of Northwestern University Feinberg School of Medicine in Chicago. The group hopes these findings will help their peers as they face future pandemics.

"[Our] data will add to the body of literature detailing the incidence of COVID-19 on CT utilization which, in turn, may aid others in prediction and institutional preparedness efforts for the current pandemic as well as future [ones]," the group wrote.

The World Health Organization's March 2020 declaration of COVID-19 as a global pandemic had dramatic effect on the healthcare system worldwide, with many hospitals canceling or postponing not only nonurgent medical procedures but also imaging studies and "stay at home" orders reducing the number of patients presenting in the emergency room, the team noted.

But despite the dampening effect of the pandemic on the healthcare system, the number of chest CT exams increased, since CT was initially one of the first imaging modalities used to diagnose the disease.

Loftus and colleagues explored the use of chest CT prepandemic and during it via a study that included ED imaging volume data between January 2019 and February 2021 taken from seven hospitals. They calculated weekly overall CT use as CT scans ordered per 100 ED visits; during the study time period, there were 618,972 ED visits and 237,053 CT exams performed.

Although mean ED visit volumes decreased from 6,063 per week prepandemic to 4,885 per week during the pandemic, the group found that the weekly use of CT in the emergency department increased, both overall and for chest CT.

Emergency department CT exam use, prepandemic and during
CT exams (weekly) Prepandemic During pandemic
Total per 100 ED visits 35.9 41.8
Chest CTs per 1,000 scans 2 5

"Compared to prepandemic baseline, there was a significant increase in rates of both overall ED CT utilization and ED CT chest utilization following the start of the COVID pandemic," the investigators reported.

The findings shed light on how CT imaging use changed in the emergency department during the COVID-19 pandemic, and they highlight the need for continued study, according to the group.

"EDs are currently encountering a large volume of patients with a relatively new disease process, one in which investigations are ongoing regarding how to best incorporate CT chest into an appropriate and evidence-based diagnostic evaluation, and for which clinical practice guidelines are yet to be developed ... These data may help formulate future operational strategies for resource utilization and imaging indications as we look towards a future with endemic or annual COVID-19 seasons," the team concluded.

Copyright © 2022

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