Trends in computed tomography utilization among emergency department patients with foot and ankle trauma

The aim of this study was to assess the number of foot/ankle computed tomography (CT) exams ordered per encounter for patients presenting to the emergency department (ED) with foot and ankle trauma over a 5-year period. Secondary aims included evaluating the positivity rate of foot/ankle CT exams and identifying factors associated with receiving a CT foot/ankle. This retrospective study analyzed data from a large urban Level-1 trauma center between 2016 and 2021. Patients were identified by charted chief complaints related to foot and ankle trauma. The primary outcome was the number of CT foot/ankle exams ordered per patient in a given period. A univariate chi-square analysis was conducted to evaluate differences in patient presentations and imaging rates across the study period. Over the 5-year span, there were 9,845 patient encounters, with a significant increase in CT foot/ankle orders from 2.4 % to 6.6 % (p < 0.001). The CT positivity rate, defined as CTs with positive findings, declined from 95.2 % in 2016 to 84.1 % in 2021 (p < 0.001). Black patients had lower odds of receiving CT scans compared to White patients, as did Medicare recipients compared to Medicaid recipients (p < 0.001). Factors such as age (OR: 1.02 per year), year of visit (OR: 2.66 for 2021), time of day (OR: 1.62 for evening arrivals), and arrival by EMS (OR: 5.60) were significantly associated with higher CT order rates. This study highlights a marked increase in CT utilization for foot and ankle trauma with a corresponding decline in the rate of positive findings. Further research is necessary to explore the reasons behind this trend and to identify potential workflow or protocol adjustments to improve imaging efficacy.