Association Between Computed Tomography Request Appropriateness and Imaging Outcomes in a Basic Emergency Department: A Retrospective Cross-Sectional Study

Abstract

Objective: To assess the appropriateness of computed tomography requests in a basic emergency department and to correlate them with the corresponding imaging findings.
Methods: A retrospective cross-sectional study was conducted using a random sample of 360 computed tomography examinations requested in 2023 at the basic emergency department of Lamego Hospital. Data collected included demographic and clinical information, exam characteristics, and the medical specialty of the requesting physician. Imaging findings were categorised accordingly. Appropriateness and relevance of findings were independently evaluated by two certified radiologists. The association between appropriateness and findings was analysed using descriptive statistics and logistic regression.
Results: A total of 360 examinations from 342 patients were analysed, with a median age of 73 years; 51.5% were female. Most examinations were requested for patients triaged as Urgent (70.3%), predominantly by physicians from General Surgery, General Medicine, and Internal Medicine (96.4%). Overall, 26.9% of examinations were deemed inappropriate, with higher rates observed in younger, male patients and those classified as Green triage level (45%). Appropriately requested examinations were significantly more likely to detect findings relevant to the emergency admission.
Conclusions: A substantial proportion of exams in this emergency department were inappropriately requested, consistent with international evidence. Appropriately requested examinations were up to six times more likely to yield findings relevant to the patient‘s emergency condition, underscoring the importance of sound clinical reasoning, adherence to guidelines, and the use of decision-support tools such as the ESR iGuide.