The Use of CT Scanners in the Emergency Department

Case Report

Austin Emerg Med. 2015; 1(1): 1003.

The Use of CT Scanners in the Emergency Department

Quek Jing Xiao¹ and Fatimah Lateef²*

¹Imperial College London, UK

²Department of Emergency Medicine, Dukes-NUS Graduate Medical School and Yong Loo Lin School of Medicine, National University of Singapore, Singapore

*Corresponding author: Fatimah Lateef, Department of Emergency Medicine, Dukes-NUS Graduate Medical School and Yong Loo Lin School of Medicine, National University of Singapore, Singapore

Received: November 13, 2015; Accepted: November 27, 2015; Published: November 30, 2015


The use of CT scanners has increased significantly over the last few decades. This is especially so in the setting of Emergency Departments (EDs), where many investigations are now being brought forward to the frontline. Third generation CT scanners now have better resolution and imaging quality, leading to the trend towards more non-invasive test. Trauma centres and tertiary referral centres too have CT scanners in their EDs, and this has reduced the time required to get a definitive diagnoses, thus improving patient outcomes.

In this paper, we reviewed some of the current indications for performing CT scans in the ED, following which we analysed the positive pick up rates for some of these indications. We evaluated the potential benefit of having CT scanners available 24 hours a day in the ED, and weighed this against the possible harm. Finally, we discussed whether or not there was a need to have these CT scanners available 24 hours a day in order to influence time-sensitive outcomes and prevent out of our complications.

Keywords: CT scanners; Emergency department; 24 hours


The use of Computed Tomography (CT) scans has skyrocketed in the last few decades, increasing approximately 21-fold, and is not yet tapering [1-4]. This increase is happening at a higher rate in the emergency department as compared to anywhere else, accounting for approximately 72% of the 62 million scans in 2009 [4,5].

With better technology and imaging quality, CT scans have become a vital part of the diagnostic process [6-9]. Increasing medico-legal pressure from patients to reach a quicker, more accurate diagnosis, coupled with a trend towards less invasive testing, has also contributed to the exponential increase in scan rates [4,9]. Moreover, more trauma centres have CT scanners in their own departments now [9,10]. This increasing ease of access leads to a shortened transfer time, hence a quicker diagnosis and better patient outcomes [10]. However, increasing numbers of scans also leads to increasing costs of healthcare and exposure to unnecessary radiation [9,11]. Is having a CT scanner in the ED leading to overutilization?

This article aims to review the indications for doing a CT scan in the ED, look at the positive pick-up rates of these scans, and subsequently analyze the need for a 24 hour CT scanner in the ED.


A search of electronic databases (MEDLINE, EMBASE etc.) was performed, using keywords such as “computed topography”, “emergency department” and “24 hours”. Articles were then narrowed down to include studies that reported CT scanner utilization rates in the ED, positive pick-up rates for certain pathologies, or those that discussed a need for 24 hour availability in the ED.


Indications for scanning in the ED

There are many different indications for scanning in the ED, ranging from chest CTs for suspected pulmonary emboli to Whole- Body CTs (WBCT) for polytrauma. The incidence of all these scans have been steadily rising [12]. Looking more specifically at head CT scans, minor head injuries [13], new onset headaches, strokelike symptoms and alterations in mental state [10] are just some of the many possible indications for scanning. As such, to tackle the problem of when to scan and when to withhold, many countries have come up with various guidelines (Table 1 and 2).