Pattern of Acute Imaging Utilization in the Emergency Unit: A Prospective Observational Study

Abstract

Background: Acute diagnostic imaging is indispensable in the Emergency Unit (EU) for time-critical decision-making. Patients presenting with acute conditions require a rapid assessment across various imaging modalities, each carrying specific risks and benefits. This study aimed to delineate the characteristics, diagnostic yield, and outcomes associated with the utilization of different imaging modalities in a high-volume tertiary care EU. Methods: A prospective, single-center observational study was conducted over an eight-month period, from January 1, 2025, to August 31, 2025. We enrolled 258 consecutive adult patients presenting to the EU who required acute imaging as part of their initial workup. Data on demographics, clinical indication, imaging type (X-ray, Ultrasound [US], Computed Tomography [CT], CT Total Body, Magnetic Resonance Imaging [MRI]), use of contrast medium, final diagnosis, and clinical outcome were systematically collected and analyzed using descriptive statistics. Results: The mean age of the cohort was 45.2 ± 18.5 years, with 142 (55.0%) patients being male. X-ray was the most frequent initial modality (98 cases, 38.0%), followed by CT scans (targeted and total body), which accounted for 87 cases (33.7%), and US for 65 cases (25.2%). Of the 87 CT procedures, 67 (77.0%) utilized intravenous contrast. Major trauma was the indication for 19 CT Total Body scans. Critical diagnoses included appendicitis (12 cases, 4.7%), subarachnoid hemorrhage (6 cases, 2.3%), and pulmonary embolism (5 cases, 1.9%). Overall, 121 patients (46.9%) were admitted, with 15 (5.8%) requiring immediate transfer to the Intensive Care Unit (ICU) or Operating Room (OR). Fifteen patients (5.8%) experienced mortality during their hospital stay. Conclusion: Imaging utilization in the EU is complex and procedure-heavy, with a significant reliance on CT. The high rate of contrast-enhanced CT underscores its necessity in achieving rapid, high-confidence diagnoses for critical conditions. These findings emphasize the need for well-defined, evidence-based imaging protocols to optimize resource allocation, ensure patient safety, and improve clinical outcomes in the acute care setting.