Pattern of Acute Imaging Utilization in the Emergency Unit: A Prospective Observational Study

Background: Acute diagnostic imaging is indispensable in the Emergency Unit (EU) for time-critical decision-making. Patients presenting with acute conditions require a rapid assessment across various imaging modalities, each carrying specific risks and benefits. This study aimed to delineate the characteristics, diagnostic yield, and outcomes associated with the utilization of different imaging modalities in a high-volume tertiary care EU.
Methods: A prospective, single-center observational study was conducted over an eight-month period, from January 1, 2025, to August 31, 2025. We enrolled 258 consecutive adult patients presenting to the EU who required acute imaging as part of their initial workup. Data on demographics, clinical indication, imaging type (X-ray, Ultrasound [US], Computed Tomography [CT], CT Total Body, Magnetic Resonance Imaging [MRI]), use of contrast medium, final diagnosis, and clinical outcome were systematically collected and analyzed using descriptive statistics.
Results: The mean age of the cohort was 45.2 ± 18.5 years, with 142 (55.0%) patients being male. X-ray was the most frequent initial modality (98 cases, 38.0%), followed by CT scans (targeted and total body), which accounted for 87 cases (33.7%), and US for 65 cases (25.2%). Of the 87 CT procedures, 67 (77.0%) utilized intravenous contrast. Major trauma was the indication for 19 CT Total Body scans. Critical diagnoses included appendicitis (12 cases, 4.7%), subarachnoid hemorrhage (6 cases, 2.3%), and pulmonary embolism (5 cases, 1.9%). Overall, 121 patients (46.9%) were admitted, with 15 (5.8%) requiring immediate transfer to the Intensive Care Unit (ICU) or Operating Room (OR). Fifteen patients (5.8%) experienced mortality during their hospital stay.
Conclusion: Imaging utilization in the EU is complex and procedure-heavy, with a significant reliance on CT. The high rate of contrast-enhanced CT underscores its necessity in achieving rapid, high-confidence diagnoses for critical conditions. These findings emphasize the need for well-defined, evidence-based imaging protocols to optimize resource allocation, ensure patient safety, and improve clinical outcomes in the acute care setting.

Acute Imaging, Computed Tomography, Contrast Media, CT Total Body, Diagnostic Yield, Emergency Medicine, Patient Safety, Ultrasound.

1. Trzeciak S, Rivers EP. Emergency department overcrowding in the United States: an emerging threat to patient safety and public health. Emerg Med J. 2003;20(5):402-5. [Google Scholar] [Crossref]

2. Kocher KE, Meurer WJ, Fazel R, Scott PA, Krumholz HM, Nallamothu BK. National trends in use of computed tomography in the emergency department. Ann Emerg Med. 2011;58(5):452-462.e3. [Google Scholar] [Crossref]

3. Hallas P, Bøtker HE, Møller-Helgestad O, et al. The role of chest X-ray in the modern emergency department. Dan Med J. 2018;65(10):A5511. [Google Scholar] [Crossref]

4. Jones LA, et al. The Role of Point-of-Care Ultrasound in the Non-Traumatic Emergency Unit. J Emerg Med. 2022;62(3):345-355. [Google Scholar] [Crossref]

5. Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med. 2011;364(8):749-57. [Google Scholar] [Crossref]

6. Lee CI, Haims AH, Monico EP, Brink JA, Forman HP. Diagnostic CT scans: assessment of patient, physician, and radiologist awareness of radiation dose and possible risks. Radiology. 2004;231(2):393-8. [Google Scholar] [Crossref]

7. Karczmar JA, et al. Radiation Dose Monitoring and Management in the Emergency Setting. Radiographics. 2019;39(4):1023-1038. [Google Scholar] [Crossref]

8. Mehran R, Dangas GD, Weisbord SD. Contrast-Associated Acute Kidney Injury. N Engl J Med. 2019;380(22):2146-2155. [Google Scholar] [Crossref]

9. Moore FO, et al. Whole-Body CT in Multi-Trauma: Rationale and Current Evidence. J Trauma Acute Care Surg. 2018;85(1):201-209. [Google Scholar] [Crossref]

10. Tekin A, et al. The utility of magnetic resonance imaging in the emergency department. Am J Emerg Med. 2017;35(5):751-754. [Google Scholar] [Crossref]

11. Brenner DJ, Hall EJ. Computed tomography--an increasing source of radiation exposure. N Engl J Med. 2007;357(22):2277-84. [Google Scholar] [Crossref]

12. The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP. 2007;37(2-4):1-332. [Google Scholar] [Crossref]

13. Davenport MS, Cohan RH, Khalatbari S, Ellis JH. The challenges in assessing contrast-induced nephropathy: where are we now? AJR Am J Roentgenol. 2014;202(4):784-9. [Google Scholar] [Crossref]

14. American College of Radiology (ACR). ACR Appropriateness Criteria®. [Internet]. Reston (VA): American College of Radiology. [Cited 2025-12-01]. Available from: https://acsearch.acr.org/list [Google Scholar] [Crossref]

15. Smith JG, et al. Trends in Emergency Department CT Utilization and Diagnostic Yield. Acad Emerg Med. 2020;27(8):710-719. [Google Scholar] [Crossref]

16. Raja AS, Pourjabbar S, Ip IK, et al. Impact of a clinical decision support tool on emergency department imaging for atraumatic abdominal pain. Am J Med. 2015;128(6):666.e1-6. [Google Scholar] [Crossref]

17. Melnick ER, Szlezak CM, Bentley SK, Dziura JD, D'Onofrio G, Jagoda A. CT overuse for mild traumatic brain injury. Jt Comm J Qual Patient Saf. 2012;38(11):483-9. [Google Scholar] [Crossref]

18. Kline JA, Mitchell AM, Kabrhel C, Richman PB, Courtney DM. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J Thromb Haemost. 2004;2(8):1247-55. [Google Scholar] [Crossref]

19. Stiell IG, Clement CM. Clinical decision rules and the future of emergency medicine. Ann Emerg Med. 2013;61(4):479-81. [Google Scholar] [Crossref]

20. Hlibczuk V, et al. Use of and yield from contrast-enhanced CT in the adult emergency department. Emerg Radiol. 2011;18(3):191-7. [Google Scholar] [Crossref]

21. Broder J, et al. The "5-Minute" MRI: A 10-Year Experience with a Protocol for the Acutely Ill Patient. Emerg Radiol. 2015;22(4):385-91. [Google Scholar] [Crossref]

22. Bellou A, et al. The role of imaging in the disposition of emergency department patients with non-traumatic abdominal pain. Eur J Radiol. 2019;118:133-138. [Google Scholar] [Crossref]

23. Carpenter CR, et al. Diagnostic yield and outcomes of emergency department patients with syncope. Acad Emerg Med. 2014;21(9):993-1001. [Google Scholar] [Crossref]

24. Singer AJ, Thode HC Jr, Hollander JE. Research fundamentals: IV. Observational study designs. Acad Emerg Med. 2004;11(9):989-95. [Google Scholar] [Crossref]

25. Levit A, et al. A systematic review of the appropriateness of diagnostic imaging in the emergency department. Am J Emerg Med. 2016;34(11):2190-2195. [Google Scholar] [Crossref]

26. Choy G, et al. Current applications and future impact of machine learning in radiology. Radiology. 2018;288(2):318-328. [Google Scholar] [Crossref]

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