Impact of COVID-19 on the volume of emergency CT studies in a neuro-trauma reference center

Rationale and Objectives The covid-19 pandemic has been a challenge for health systems, given the large number of affected patients and mortality rates. However, it has conditioned a decrease in non-covid imaging studies. Our intention is to quantify the decrease in emergency neuroimaging studies caused by the pandemic. Materials and Methods A retrospective study was carried out on the number of CTs requested from the emergency department. The total amount of CT performed, brain-CT, and the CT studies for stroke code were quantified, week by week. The analogous weeks of 2019 and 2020, before and after the declaration of the state of alarm, were compared. Results The total amount of CTs requested from the ED during 2020 in weeks 1-12 was 1266, and decreased compared with 1745 exams during weeks 1-12 in 2019 (p value 0.045). During weeks 1-12 in 2020, 947 brain-CTs were performed, compared to 1328 in 2019 (p value 0.032). When comparing the 1-6 weeks in 2020 with those affected by the pandemic, a decrease was observed from 887 emergency CTs to 419 (p value 0.002). There was a decrease (p value 0.002) in the number of brain-CTs, from 664 in weeks 1-6, to 303 in weeks 7-12. No statistically significant differences were found in the number of stroke code studies. Conclusion The COVID-19 pandemic has led to a huge drop in urgent imaging studies during the state of alarm at a reference neurotrauma center, except for stroke code studies. Keywords: Covid-19; Neuroimaging; Stroke imaging; Emergency imaging; CT

Impact of the COVID-19 pandemic on emergency department CT for suspected diverticulitis: A natural experiment to explain patients’ and clinicians’ assessment of risk and willingness to undergo CT scanning?

Purpose: This study examined the impact of the COVID-19 pandemic on emergency department CT use for acute non-traumatic abdominal pain, to better understand why imaging volume so drastically decreased during the COVID-19 pandemic.Methods: This was a retrospective review of emergency imaging volumes from January 5 to May 30, 2020. Weekly volume data were collected for total imaging studies, abdominopelvic CT, and abdominopelvic CTs positive for common causes of acute non-traumatic abdominal pain. Two emergency radiology attendings scored all diverticulitis cases independently and weekly volume data for uncomplicated and complicated diverticulitis cases was also collected. Volume data prior to and during the COVID-19 pandemic was compared, using 2019 volumes as a control.Results: During the COVID-19 pandemic, overall emergency imaging volume decreased 30% compared to 2019 (p = 0.002). While the number of emergency abdominopelvic CTs positive for appendicitis and small bowel obstruction did not significantly change during the COVID-19 pandemic, the number of cases of diverticulitis decreased significantly compared to 2019 (p = 0.001). This reduction can be specifically attributed to decreased uncomplicated diverticulitis cases, as the number of uncomplicated diverticulitis cases dropped significantly (p = 0.002) while there was no significant difference in the number of complicated diverticulitis cases (p = 0.09). Conclusions: Reduced emergency abdominopelvic CT volume during the COVID-19 pandemic can partially be explained by decreased imaging of lower acuity patients. This data may help formulate future strategies for imaging resource utilization with an improved understanding of the relationship between perceived imaging risk and symptom acuity.