Real-World Use of CT Angiography in Emergency Department Patients With Gastrointestinal Bleeding

Computed tomography angiography (CTA) is increasingly used in the ED for the evaluation of patients suspected of significant gastrointestinal bleeding (GIB). Real world utilization patterns and associated downstream clinical events are incompletely described. We sought to characterize CTA use among ED encounters for suspected GIB and examine associated clinical outcomes.

We conducted a retrospective observational cohort study using EHR data from a single tertiary care hospital (annual ED volume 100,000). Adult encounters were included if the ED chief complaint indicated suspected GIB or if a GIB-protocol CTA was ordered. We described patient characteristics, CTA utilization rates, and downstream outcomes. Summary statistics and CTA utilization trends were reported.

During a five-year period ending in 2025, 3963 encounters were identified by GIB chief complaint and 582 by undergoing GIB-protocol CTA. Among GIB chief complaint encounters, 19% had CTA, increasing over the study period (2021: 17%; 2025: 23%). The median age of this cohort was 56. The admission rate was 42% and stable over the period. During the encounter, transfusion occurred in 16%; IR procedure in 3%, colonoscopy in 2% and all-cause mortality was 1.5%. Extended all cause mortality was 3.1% at 30 days, 4.6% at 90 days and 7.7% at 1 year. Patients identified by CTA alone had a median age of 63 years, an admission rate of 75%, transfusion 41%, IR 6%, colonoscopy 2% and 5.2% mortality during the encounter. Mortality was 7.8%, 11.2% and 17.1% at 30 days, 90 days and 1 year, respectively.

CTA is used in one fifth of GI bleeding related visits at our hospital and is increasing modestly. Patients are admitted at a higher proportion to our overall admission rate and death was uncommon during the visit. Transfusions are the most common intervention, four fold more than IR or colonoscopy. Patients who had a GIB-protocol CTA without a discrete chief complaint of GIB were older and had higher rates of admission, transfusion, IR procedure and all cause mortality.