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Research Letter | Less Is More

Use of Computed Tomography in Emergency Departments in the United States A Decade of Coughs and Colds

Frank S. Drescher, MD1,2,3; Brenda E. Sirovich, MD, MS1,2,4
[+] Author Affiliations
1Outcomes Group, VA Medical Center, White River Junction, Vermont
2Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
3Pulmonary and Critical Care Medicine, Veterans Affairs, White River Junction, Vermont
4The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire
JAMA Intern Med. 2016;176(2):273-275. doi:10.1001/jamainternmed.2015.7098.
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This study examines the trends in the use of computed tomography in patients who present to emergency departments with respiratory symptoms.

Computed tomography (CT) can be an essential tool in guiding the management of acute or life-threatening pulmonary disease. Increasing use of CT, however, has raised concerns about the effects of ionizing radiation on organs within the radiation field, including the thyroid, lungs, and breast.1 Beyond the risk posed by ionizing radiation, high resolution CT may have unintended downstream consequences related to incidental findings and overdiagnosis, leading to a costly and potentially harmful diagnostic, therapeutic, or interventional cascade.2 Increasing use of CT is most concerning among patients with the least to gain (eg, patients with illnesses of low acuity or at low risk of serious pathological conditions) or the most to lose (eg, young patients in whom CT carries the greatest risk of causing future radiation-related cancers). We sought to examine trends in the use of CT, and in clinical decision-making, for patients presenting to the emergency department (ED) with respiratory symptoms.

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Figure.
Ten Years of CT Use for Adults With Respiratory Symptoms Presenting to EDs of US Hospitals, by Acuity and Symptom Location (2001-2010)

Crude estimates are shown. CT indicates computed tomography; ED, emergency department; lower, lower respiratory tract; upper, upper respiratory tract.

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