Retrospective Study of CT Scan Indications in Adult Emergency Departments: Are They Justified and Aligned With Official Guidelines

CT scans are widely used in modern emergency departments, facilitating the diagnosis of both urgent and non-urgent conditions. However, a noticeable increase in the use of imaging-particularly CT scans-has been observed in recent years. This trend can be attributed to several factors, including technological advancements that have made imaging more accessible, as well as a rising number of patients presenting to emergency departments.

Nevertheless, studies have raised concerns about the appropriateness of this increase. Notably, Keith E. Kocher et al. reported that between 1996 and 2007, the number of emergency department visits in a U.S. hospital increased by 30%, while the number of CT scans performed rose by an astonishing 330% over the same period. This disproportionate rise raises questions about the justification of many of these examinations, especially considering the potential consequences-ranging from increased healthcare costs and radiation exposure to environmental impact.

Imaging examinations such as CT scans are associated with significant costs and expose patients to ionizing radiation. It has been demonstrated that CT-related radiation is linked to an increased risk of cancer, particularly with high or cumulative doses, thereby posing a public health concern. In addition, the environmental impact of CT imaging should not be overlooked: each scan generates approximately 2 kg of CO₂, contributing to global warming. These concerns highlight the importance of using CT scans judiciously and minimizing unjustified imaging whenever possible, in order to limit both medical and ecological consequences.

At the international level, several studies have highlighted significant variability in the rate of unjustified CT scans. For example, Heljä Oikarinen et al. (2009) reported that in a Swedish hospital radiology department, 77% of lumbar spine CT scans, 36% of brain CT scans, and 37% of abdominal CT scans were unjustified in patients under the age of 35. More recently, Andreas Sakkas et al. (2023) found that 37.8% of brain CT scans performed for head trauma in a German maxillofacial surgery department were unjustified. In contrast, Aleksandra Sobiecka et al. (2019) reported a much lower rate-only 6.54% of CT and MRI scans were deemed unjustified-across two radiology departments in Poland.

These divergent findings from country to country underscore the complexity of assessing imaging appropriateness and highlight the need for local evaluations. Given the public health implications in France-including healthcare costs and radiation exposure-as well as the global environmental impact of medical imaging, the investigators have undertaken a retrospective observational study in the adult emergency department of Hôpital Sainte Musse. The objective is to assess the justification of CT scans prescribed in this setting. More specifically, the investigators aim to calculate the proportion of CT scans that are justified either by adherence to official clinical guidelines or by a subsequent change in patient management resulting from the imaging findings.