Sept. 8, 2010 — Advanced medical imaging is increasingly being used to evaluate emergency room patients complaining of chest or abdominal pain, the CDC says in a new report.
For chest pain, advanced techniques such as CT scans and magnetic resonance imaging (MRI) increased 367% in the 1999-2008 period, study author Farida Bhuiya, MPH, tells WebMD.
And the same techniques used on ER patients with abdominal pain have increased 122.6%.
“This really stood out to us,” Bhuiya says. “Is this increase in medical imaging helping us narrow down serious visits and weeding out those that are not as serious, or is imaging being used in excess? We don’t know the answer to that, but we kind of put it out there.”
NCHS Data Brief
The report, the CDC’s National Center for Health Statistics’ Data Brief No. 43 for September 2010, says CT scans and MRIs may help doctors rule out or diagnose serious medical conditions, leading to more effective and efficient treatment.
The report also finds that in the same 1999-2008 period:
- The percentage of emergency room visits for which chest pain was the primary cause decreased 10%. The percentage of ER visits for chest pain that resulted in a diagnosis of acute coronary syndrome decreased 44.9%, from 23.6% in 1999 to 13% in 2007-2008.
- The number of emergency room visits for chest pain was 5 million in 1999-2000, and 5.5 million in 2007-2008.
- The number of non-injury ER visits in which abdominal pain was the main complaint increased 31.8%, from 5.3 million to 7 million.
- The overall number of non-injury emergency room visits rose 22.1%, from 50.5 million in the 1999-2000 period to 61.7 million in 2007-2008.
Arrival to ER by Ambulance
The researchers also investigated whether the number of people with chest or abdominal pain arriving at emergency departments by ambulance has been increasing.
The answer was in the affirmative for people with abdominal pain, with the number of patients arriving by ambulance at ERs increasing 26.9% in 2007-2008 over 1999-2000 levels.
No significant difference was found in percentages of people arriving in ERs by ambulance for chest pain.
However, the report states that patients with chest pain were more likely to arrive by ambulance at emergency departments, compared to patients with other symptoms in the four time periods studied, 1999-2000, 2003-2004, 2005-2006, and 2007-2008.
For example, in the 2007-2008 period, 25.8% of patients reporting by ambulance to emergency rooms had chest pain, compared to 12.6% with abdominal pain and 16% with other symptoms.
Other findings from the report:
- The percentage of chest pain visits that needed immediate treatment was two to three times higher than the percentage of visits for abdominal pain or visits for other symptoms.
- The percentage of visits for chest pain resulting in admission, transfer, or death declined 17.2% from 1999-2000 through 2007-2008.
Imaging Consequences and Conclusions
“Advanced imaging may increase the amount of time that a patient spends in the ED [emergency department], thereby … contributing to ED crowding and its adverse consequences,” the authors write. “However, advanced imaging may help a physician to rule out conditions, thereby avoiding further unnecessary or risky diagnosis and therapy, and it may help confirm certain conditions, thereby leading to more effective and efficient therapy.”
The researchers conclude that “targeted research” is needed to clarify whether medical imaging is improving the diagnosis and treatment of serious conditions.