Computed Tomographic Angiography and Yield for Gastrointestinal Bleeding in the Emergency Department
Siona Prasad1,2, C Michael Hood1,2,3, Cameron Young1,2
1Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Mass General Brigham, Boston, Massachusetts.
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.
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