Objective: To retrospectively analyse the use of imaging studies in the Emergency\nDepartment of community hospitals using evidence based guidelines\nand clinical judgement. Methods: Medical records of 661 patients who visited\nthe Emergency Department (ED) in 2015 and underwent imaging studies\nwere reviewed. The Canadian Association of Radiologists, American College\nof Radiologists and Choosing Wisely Canada guidelines were used to determine\nthe appropriateness of imaging studies. The use of prior patient imaging,\nthe rate at which studies were repeated and the respective impacts on patient\nmanagement of the imaging studies were also examined. Results: Of the\n1056 imaging studies reviewed, 228 (22%) were found to be clinical situations\nwhere no imaging study was indicated while 168 (16%) were considered a\nsuboptimal choice of imaging study or modality. When no study was recommended,\na positive impact on the diagnosis was noted in 105 (46%) cases and\non patient management 83 (36%) times. Notably, 219 (21%) patients had a\nrelevant examination performed in the last 30 days, and 147 (14%) reports\nnoted that the results of the prior study also concurred with the imaging\nstudy evaluated. Conclusion: In this study, 228 (22%) radiographs and CT\nstudies, excluding MVC related imaging and extremity imaging, were not indicated\nbased on appropriateness criteria and consequently had a limited impact\non patient management. This supports the need for increased clinical\ndecision support for ED physicians, regional health information exchanges\nand consideration of Computerized Physician Order Entry in the ED with\nembedded appropriateness criteria at the point of ordering.
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