Emergency CT Use for Minor Spine Injuries Is On the Rise

CT use is on the rise with patients who have minor injuries. As a result, emergency departments are seeing more and more cervical spine imaging.

In a study published Aug. 2 in the Journal of the American College of Radiology, a team of investigators from Emory University and Massachusetts General Hospital revealed that the number of spine scans have tripled among some groups. In fact, across the country, spine injuries account for more than 800,000 of the 40 million scans captured every year in emergency departments.

Minor trauma accounts for most of these images, they said.

“Although [injury severity score] is typically used as a tool for research and quality improvement and is not available in real time, we believe our observations could nonetheless inform ongoing efforts (e.g. Choosing Wisely initiatives, decision support tools, pre-authorization processes, and consensus statement for optimizing [emergency department] imaging) to ensure the most appropriate use of cervical spine imaging in the acute setting,” the team said.

Theirs is the first study to analyze imaging utilization with claim-based injury severity scores.

For their study, the team evaluated the records for 11,346,684 trauma encounters in the emergency department that occurred between 2009 and 2018. Using an injury severity score algorithm with diagnosis codes, they categorized injuries as minor, intermediate, and major. Overall, the team determined that minor injuries were part of 68 percent of emergency department visits while intermediate and major injuries accounted for 31 percent and 0.6 percent, respectively.

According to their analysis, not only did cervical spine imaging spiked by 5.7 percent each year, but CT scans also ballooned by 10.5 percent annually. In contrast, radiography fell by 2.7 percent each year. The biggest CT utilization increases occurred with minor injuries, but radiography use was consistent. However, for intermediate and major visits, radiography was less common.

Based on these results, more work is needed to curtail CT utilization, they concluded. Focusing on clinical decision support tools could be an effective way to control imaging use with these minor injuries.

“Our work suggests that an increase focus on CT imaging may be warranted in similar future initiatives,” they said. “Further study is necessary to assess appropriateness, implications on costs and population radiation dose, and factors influencing ordering decision making.”

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