The reassurance of a CT scan in the emergency department

There’s little question that CT scans are on the rise, especially in the emergency department.

A recent paper from Radiology put a number to the increased frequency of the test, concluding,

CT, a radiology tool that once took nine days to finish, was used 16.2 million times in 2007 to diagnose headaches, stomach aches, back pain, chest pain and the like. That was a huge increase from 1995 when it was used 2.7 million times.

To anyone working in the medical profession, it’s hardly a surprise.

David Larson, author of the study, puts it this way: “Because it’s so widely available, because the images are so exquisite, there’s the temptation to use it for anything … we may be heading toward overutilization or inappropriate utilization.”

Heading toward overtuilization? I’d say we’re already there.

I’ve written several times on this blog that, in addition to the concerns about radiation, there is the real possibility that false positives and incidentilomas from CT scan findings need to be considered in the decision making process.

To many patients however, those arguments pale when compared to the reassurance provided by a negative scan.

Jeff Goldsmith, an author who provides a patient perspective,

says it’s different when you’re the one lying on the table with a stabbing pain in your gut. He has twice had CT scans for abdominal pain and says he was “grateful” the scan could diagnose his problem and lead to quick treatment.

And that’s the mentality prevailing in the American public. Instant gratification, when, in many cases, watchful waiting may suffice.

The rising use of CT scans, which each cost hundreds of dollars, is a strong driver in rising health costs.

But those dollars pale in comparison to the reassurance of a negative scan, which is priceless in the minds of patients.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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  • http://skepticalscalpel.blogspot.com/ Skeptical Scalpel

    I could not agree with you more. I blogged about this 3 months ago (http://bit.ly/gzkJr5) in response to a Perri Klass NY Times article (http://nyti.ms/hT0EtT) calling for fewer CT scans in children. Patients and their families demand CT scans and accurate diagnoses. It will be hard, if not impossible, to re-educate the public.

  • http://www.MDWhistleblower.blogspot.com Michael Kirsch, M.D.

    CT scans of the abd, the new ‘physicial exam’, should not be ordered primarily to reassure, although I agree this is a welcome result. It tends to be ordered reflexively and may do more harm than good, considering the cost and the medical spiral that results when inconsequential lesions are found.

  • Paul Dorio

    Careful, now, Dr Kirsch. I agree with the blog post and your comments. But “incidentalomas” do not equal “inconsequential lesions.” By following Kevin’s use of the former with your use of the latter term the reader may conclude that incidental findings are not clinically relevant, harmful or important. Mostly, I use the term “incidentalomas” to refer to adrenal masses, which tend to be benign adenomas, or renal masses, which tend to be malignant kidney cancers. Important discussions can be had regarding the utility of finding these types of abnormalities…”incidentally.”

  • http://www.MDWhistleblower.blogspot.com Michael Kirsch, M.D.

    Thanks, Paul, for your comment. I’m sure we both agree that CT scans are showing nodules, thickenings, prominences and various irregularites in several organs that are not pathological, but serve to light the fuse for a medical cascade, which costs money and generates high anxiety for patients and families. It is a complex situation. I think that effective tort reform would be an important part of the solution.

    • http://drpauldorio.com Paul Dorio

      Yes yes and YES.

  • Muddy Waters

    I’m all for patient’s peace of mind, as long as I don’t have to pay for it. And by the way, where on earth do CT scans cost “hundreds of dollars?” In med school, I received an abdominal CT at a cool $6000. Ouch.

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