We overuse computed tomography for many things – popular topics in the literature (and on this blog) are mostly minor head injury, renal colic, and CT pulmonary angiograms. But, it is not simply these modalities that have increased in the preceding decades, as this research letter shows. CT use has also increased for such apparently benign conditions as non-acute upper respiratory symptoms.
This is a National Hospital Ambulatory Medical Care Survey analysis, with all the sampling limitations inherent to such a data source, evaluating CT usage for upper and lower respiratory complaints between 2001 and 2010. CT usage in 2001 for such complaints ranged from a 0.5% of visits for non-acute URI, to 3.1% of visits for acute LRTI symptoms. In 2010, such usage ranged from 3.6% to 12.1%. Despite all this added cost and extensive evaluation, management of these patients remained unchanged: both antibiotic use and admission rates were steady.
The NHAMCS is an imprecise tool to full discern the reasons for visit on a granular level, but the relative increase in advanced imaging is consistent with increases in CT usage for other indications. Obviously, the radiation itself has no known therapeutic potential – so, therefore, the clear conclusion is simply the unfortunate presence of additional low-value care.
“Use of Computed Tomography in Emergency Departments in the United States: A Decade of Coughs and Colds”