Factors associated with imaging overuse in the emergency department: A systematic review

Monica Tung, Ritu Sharma, Jeremiah S. Hinson, Stephanie Nothelle, Jean Pannikottu, Jodi B. Segal

Research output: Contribution to journalReview articlepeer-review


Background: Emergency departments (ED) are sites of prevalent imaging overuse; however, determinants that drive imaging in this setting are not well-characterized. We systematically reviewed the literature to summarize the determinants of imaging overuse in the ED. Methods: We searched MEDLINE® and Embase® from January 1998 to March 2017. Studies were included if they were written in English, contained original data, pertained to a U.S. population, and identified a determinant associated with overuse of imaging in the ED. Results: Twenty relevant studies were included. Fourteen evaluated computerized tomography (CT) scanning in patents presenting to a regional ED who were then transferred to a level 1 trauma center; incomplete transfer of data and poor image quality were the most frequently described reasons for repeat scanning. Unnecessary pre-transfer scanning or repeated scanning after transfer, in multiple studies, was highest among older patients, those with higher Injury Severity Scores (ISS) and those being transferred further. Six studies explored determinants of overused imaging in the ED in varied conditions, with overuse greater in older patients and those having more comorbid diseases. Defensive imaging reportedly influenced physician behavior. Less integration of services across the health system also predisposed to overuse of imaging. Conclusions: The literature is heterogeneous with surprisingly few studies of determinants of imaging in minor head injury or of spine imaging. Older patient age and higher ISS were the most consistently associated with ED imaging overuse. This review highlights the need for precise definitions of overuse of imaging in the ED.

Original languageEnglish (US)
Pages (from-to)301-309
Number of pages9
JournalAmerican Journal of Emergency Medicine
Issue number2
StatePublished - Feb 2018


  • Emergency department
  • Health care costs
  • Imaging
  • Overuse
  • Quality measurement

ASJC Scopus subject areas

  • Emergency Medicine


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