I am going to say a statement that is going to be shocking to some of you: There has been a decline in CT use by the emergency department over the last 2 decades, according to Raja et al. Can you believe it? I couldnt either. I previously thought, now that CT is so easy to get, of course everyone is ordering them more. There have been several studies showing an increase in ionizing radiation exposure over the last decade, so the results are a bit confusing. Im sure when compared to 20+ years ago, we are ordering more in total, but the trend may be that we are declining in ordering. Well, not only has Raja came to this conclusion, but when seeing how the FAST scan has affected abdominal CT scan orders, then it makes me wonder if point of care ultrasound (POCUS) is one of the main reasons for this trend. Yeah, I know, it’s a stretch, but I cannot imagine it isnt a factor, along with ALARA, and other discussions on radiation exposure.
In a study by Sheng et al – which includes some of my heroes, Drs. Vickie Noble and Andrew Liteplo – they looked at the trend of abdominal CT orders in adult trauma patients at their institution. Could it be that bedside ultrasound has effected CT orders everywhere? Their abstract is below:
Objective. We sought to describe the trend in abdominal CT use in adult trauma patients after a point-of-care emergency ultrasound program was introduced. We hypothesized that abdominal CT use would decrease as FAST use increased. Methods. We performed a retrospective study of 19940 consecutive trauma patients over the age of 18 admitted to our level one trauma center from 2002 through 2011. Data was collected retrospectively and recorded in a trauma registry. We plotted the rate of FAST and abdominal CT utilization over time. Head CT was used as a surrogate for overall CT utilization rates during the study period. Results. Use of FAST increased by an average of 2.3% (95% CI 2.1 to 2.5, P < 0.01) while abdominal CT use decreased by the same rate annually. The percentage of patients who received FAST as the sole imaging modality for the abdomen rose from 2.0% to 21.9% while those who only received an abdominal CT dropped from 21.7% to 2.3%. Conclusions. Abdominal CT use in our cohort declined while FAST utilization grew in the last decade. The rising use of FAST may have played a role in the reduction of abdominal CT performed as decline in CT utilization appears contrary to overall trends.