Utilization of Chest and Abdominopelvic CT for Traumatic Injury From 2011 to 2018: Evaluation Using a National Commercial Database.

Recent increases in utilization of CT in patients presenting with trauma have raised concern of inappropriate imaging. The evolving utilization of CT for trauma evaluation may be impacted by injury severity. To explore patterns in utilization of chest and abdominopelvic CT among trauma-related emergency department (ED) visits across the United States. This retrospective study used national commercial claims information extracted from the IBM MarketScan Commercial Database. Trauma-related ED encounters were identified from the 2011 to 2018 MarketScan files and classified using the Injury Severity Score (minor, intermediate, or major injuries) based on International Classification of Diseases codes. ED encounters were also assessed for chest CT, abdominopelvic CT, and single-encounter thoracoabdominopelvic CT examinations. Utilization per 1000 trauma-related ED encounters was determined. Multivariable Poisson regression models were used to determine incidence rate ratios (IRRs) as a measure of temporal changes in utilization. From 2011 to 2018, 8,369,092 trauma-related ED encounters were identified (5,685,295 for minor, 2,624,944 for intermediate, and 58,853 for major injuries). Utilization of chest CT per 1000 trauma-related ED encounters increased from 4.9 to 13.5 (adjusted IRR, 1.15 per year) [2.2 to 7.7 (1.17) for minor, 8.5 to 21.5 (1.16) for intermediate injuries, and 117.8 to 200.1 (1.08) for major injuries]. Utilization of abdominopelvic CT per 1000 trauma-related ED encounters increased from 7.5 to 16.4 (1.12) [4.8 to 12.2 (1.13) for minor, 10.6 to 21.7 (1.13) for intermediate, and 134.8 to 192.6 (1.07) for major injuries]. Utilization of single-encounter thoracoabdominopelvic CT per 1000 trauma-related ED encounters increased from 3.4 to 8.9 (1.16) [1.1 to 4.6 (1.18) for minor, from 6.4 to 16.4 (1.16) for intermediate, and 99.6 to 179.9 (1.08) for major injuries]. National utilization of chest and abdominopelvic CT for trauma-related ED encounters increased in commercially insured patients from 2011 to 2018, particularly for single-encounter thoracabdominopelvic CT examinations and for minor injuries. Given concerns of increased cost and incidental findings detection, further investigation is warranted to explore the potential benefit of single-encounter thoracabdominopelvic CT examinations in patients with minor injuries, as well as strategies to optimize order appropriateness.