Trends in the rates of radiography use and important diagnoses in emergency department patients with abdominal pain

Med Care. 2009 Jul;47(7):782-6. doi: 10.1097/MLR.0b013e31819748e9.


Background: Computed tomography (CT) and ultrasound (US) are used in emergency departments (ED) to aid in the diagnosis of patients with abdominal pain.

Objectives: To describe trends in CT and US use in United States EDs and determine if higher test use is associated with higher detection rates for intra-abdominal illnesses commonly detected on CT and US and lower hospital admission rates.

Research design: Retrospective study using the 2001 to 2005 National Hospital Ambulatory Medical Care Survey, a nationally representative sample of ED encounters.

Subjects: ED patients presenting with abdominal pain.

Measures: Annual rates of and trends in CT and US use, rates of intra-abdominal illnesses, hospital admission rate.

Results: Abdominal pain visits accounted for 38.8 million encounters; 17.8% received a CT and 11.7% received an US. CT use increased from 10.1% in 2001 to 22.5% in 2005 (P < 0.001). US use increased from 11.1% in 2001 to 13.6% in 2005 (P = 0.002). During the same period, detection rates for appendicitis, diverticulitis, and gall bladder disease did not increase and admission rates did not decrease.

Conclusion: Despite a more than doubling in CT use and increases in US use, there was no increase in detection rates for appendicitis, diverticulitis, and gall bladder disease nor was there a reduction in admissions.

MeSH terms

  • Abdominal Pain / diagnosis*
  • Abdominal Pain / epidemiology
  • Abdominal Pain / etiology
  • Adult
  • Appendicitis / complications
  • Appendicitis / diagnosis
  • Appendicitis / epidemiology
  • Delivery of Health Care / trends
  • Diverticulitis / complications
  • Diverticulitis / diagnosis
  • Diverticulitis / epidemiology
  • Emergency Service, Hospital / trends*
  • Emergency Treatment / trends*
  • Female
  • Gallbladder Diseases / complications
  • Gallbladder Diseases / diagnosis
  • Gallbladder Diseases / epidemiology
  • Health Care Surveys
  • Humans
  • Insurance, Health / trends
  • Linear Models
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Patient Admission / trends
  • Patient Selection
  • Practice Patterns, Physicians' / trends
  • Retrospective Studies
  • Tomography, X-Ray Computed / trends*
  • Ultrasonography / trends*
  • United States / epidemiology
  • Unnecessary Procedures / trends