Importance Overuse of advanced imaging in the emergency department (ED) contributes to higher costs, reduced efficiency, and crowding. Computed tomographic angiography (CTA) is a recommended first-line diagnostic for acute gastrointestinal bleeding (GIB), yet its increasing use may not always improve detection of active bleeding. Objective To evaluate recent trends in CTA use for suspected GIB in the ED and assess changes in diagnostic yield. Design, Setting, and Participants This retrospective cohort study included all adult patients who underwent CTA of the abdomen and pelvis for suspected GIB at a 1011-bed urban academic medical center between January 2017 and December 2023. Exposure Suspected GIB prompting a CTA order in the ED. Main Outcomes and Measures The primary outcome was the annual number and proportion of GIB-related CTAs among all ED computed tomography (CT) examinations. The secondary outcome was the test-positive proportion (diagnostic yield), defined as the percentage of CTAs showing active bleeding or evidence of hemorrhage. All CTAs were interpreted by board-certified emergency radiologists and reviewed by a fellowship-trained emergency radiologist. Results Among 954 ED patients (mean SD age, 66.7 6.3 years; 427 female 44.8%), the number of GIB-related CTA examinations increased from 30 of 32 197 ED CT examinations (0.09%) in 2017 to 288 of 44 423 (0.65%) in 2023. Over the same period, the test-positive proportion declined from 6 of 30 (20.0%) in 2017 to 18 of 288 (6.3%) in 2023. Multivariable analysis showed that more recent calendar year was associated with lower odds of a test-positive examination (OR, 0.84; 95% CI, 0.73-0.96; P = .01), older age with higher odds (OR, 1.02; 95% CI, 1.00-1.04; P = .02), and active cancer with lower odds (OR, 0.35; 95% CI, 0.12-1.00; P = .05). Conclusions and Relevance CTA use increased substantially over 7 years while diagnostic yield declined. This trend highlights the need to balance the diagnostic benefit of CTA with interpretation time, radiation exposure, and operational strain. These findings support a need for evidence-based ordering criteria and decision-support tools to help guide CTA use in the ED evaluation of gastrointestinal bleeding.
Prasad et al. (Fri,) studied this question.