Authors: Rachel R. Wu, Michael N. Adjei-Poku, Rachel R. Kelz, Gregory L. Peck, Ula Hwang, Anne R. Cappola, Ari B. Friedman
Journal: Academic Emergency Medicine, September 2024
Conclusions: ED visits for abdominal pain have increased across all adult age groups, with CT scan usage becoming more common, especially in older adults. Test positivity has also improved over time, suggesting that imaging is being used more effectively. However, the continued use of X-rays in older adults with abdominal pain, despite their limited diagnostic utility, highlights a potential area for practice improvement. The findings suggest that, overall, CT and ultrasound are being used appropriately, though efforts to reduce ineffective imaging practices such as X-rays are warranted.
Methods: The study utilized weighted, nationally representative data from the National Hospital Ambulatory Medical Care Survey (2007-2019), focusing on adult ED visits with a primary reason for visit (RFV) of abdominal pain. A total of 23,364 sampled visits were analyzed, representing 123 million visits. Data were segmented by age groups (18-45, 46-64, 65+), and trends in the use of computed tomography (CT) scans, ultrasound, and X-rays were examined. The proportion of emergency general surgical diagnoses (test positivity) after imaging was also assessed.
Results:
- Increased Visits: From 2007 to 2019, ED visits for abdominal pain increased significantly across all age groups: 18-45 years (p < 0.001), 46-64 years (p < 0.001), and 65+ years (p = 0.032).
- CT Scan Rates: The percentage of visits where a CT scan was performed increased from 26.2% in 2007 to 42.6% in 2019. The largest relative increase was among older adults (30.3%), compared to middle-aged (24.0%) and younger adults (15.0%).
- Test Positivity: Test positivity, or the likelihood of receiving a surgical diagnosis after a CT or ultrasound, increased from 17.2% in 2007 to 22.9% in 2019 (p < 0.01).
- X-ray Usage: Despite the rise in more effective imaging modalities, 13% of older adults with abdominal pain in 2019 received only an X-ray, which is neither sensitive nor specific for identifying acute abdominal pathology in this age group.