Factors Associated with Abdominal-Pelvic Computed-Tomography Scan Utilization in United States Emergency Department Visits by Adults Reporting Diarrhea (2016–2022)

Background: Adults with diarrhea are frequently evaluated in emergency departments (EDs) in the United States (US). Abdominal/pelvic computed tomography (CT) can help explore intra-abdominal pathologies that require more extensive management than ordinary diarrheal illnesses. Objectives: We investigated the frequency of abdominal/pelvic CTs obtained during US ED visits by adults with diarrhea and identified factors associated with CT utilization. Methods: We analyzed the National Hospital Ambulatory Medical Care Survey (NHAMCS-ED) (2016–2022) for visits by patients ≥ 18 years old with diarrhea. We created logistic regression models to identify patient and healthcare provider factors associated with abdominal/pelvic CT utilization. Results: Of the 991,668,111 million visits to US EDs from 2016 to 2022, diarrhea accounted for 24,206,047 visits (2.4%), of which 32% (7,674,497 visits) included abdominal/pelvic CT scanning. From 2016 to 2022, abdominal/pelvic CT scan utilization increased by 4.5% for ED visits when patients reported diarrhea and abdominal pain, yet increased by 2% when abdominal pain was not reported. In the multivariable analysis, increasing age, abdominal pain, and hypotension were associated with greater CT utilization. Non-Hispanic Blacks were less likely than non-Hispanic Whites to undergo CT scanning. Conclusions: Almost one-third of US ED adult visits for diarrhea included an abdominal/pelvic CT scan. Our findings also raise concerns about possible racial biases influencing CT scan ordering for non-Hispanic Black patients. Given the rising use of CT scans among adults presenting with diarrhea in EDs and the potential racial disparities, further prospective research evaluating the appropriateness and outcomes of this practice could inform whether future guidance would be valuable.