Trends in CT Utilization and Diagnostic Yield for Abdominal Pain in United States Emergency Departments, 2016–2022

Abdominal pain is a common and diagnostically challenging reason for emergency department (ED) visits. Use of abdominopelvic computed tomography (CTAP) for abdominal pain has increased substantially, positioning EDs as acute diagnostic centers while raising concerns about imaging overuse. However, it remains unclear whether increasing imaging intensity has translated into improved diagnostic yield, and whether observed changes reflect greater CTAP use, shifts in patient case mix, or evolving clinical practice.

We analyzed nationally representative data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) for adult ED visits with a primary reason for visit of abdominal pain from 2016-2022. Survey weights were applied to generate national estimates. Temporal trends in CTAP utilization and diagnostic yield were assessed using survey-adjusted Rao-Scott chi-square tests and multivariable survey-weighted logistic regression models adjusting for patient- and facility-level characteristics. Encounters with pregnancy-related reasons for visit or discharge diagnoses were excluded.

Among 93,888 sampled adult ED visits, representing an estimated 760 million ED encounters nationally (95% confidence interval [CI] 685-834 million), approximately 51 million visits (12.2%, 95% CI 11.7%-12.6%) were for abdominal pain. Of these, an estimated 41.4 million visits (44.8%, 95% CI 42.7%-46.9%) involved CTAP imaging, yielding 6.8 million diagnoses of emergency care-sensitive abdominal conditions (16.4%, 95% CI 15.1%-17.9%). CTAP use increased from 38.1% of abdominal pain visits in 2016 (95% CI 34.8%-41.5%) to 48.4% in 2022 (95% CI 43.0%–54.0%). Both CTAP use and diagnostic yield increased over time after adjustment, with 7% higher odds of CTAP use per year (adjusted odds ratio [aOR] 1.03-1.11; p

CTAP utilization and diagnostic yield for abdominal pain both increased modestly. Persistent increases in diagnostic yield after multivariable adjustment suggest incremental improvements in diagnostic efficiency rather than changes in patient case mix alone. These findings highlight potential diminishing returns of escalating imaging intensity and underscore the need for more targeted, value-based diagnostic strategies for abdominal pain in the ED.