Emergency Radiology

, Volume 26, Issue 2, pp 161–168 | Cite as

Emergency department imaging superusers

  • Tarek N. HannaEmail author
  • Suprateek Kundu
  • Kush Singh
  • Michal Horný
  • Daniel Wood
  • Adam Prater
  • Richard DuszakJr
Original Paper



To identify and characterize the most frequent users of emergency department (ED) imaging.

Materials and methods

All patients with at least one ED visit in 2016 across a four-hospital healthcare system were retrospectively identified and their ED imaging utilization characterized.


Overall, 126,940 unique patients underwent 187,603 ED visits (mean 1.5 ± 1.7) and a total of 192,142 imaging examinations (mean 1.7 ± 2.7). Fifty-eight percent of patients were imaged (73,672) and underwent a mean 2.6 ± 2.7 exams. When ranked by ED visits, 1.6% (2007) of patients had ≥ 4 ED visits (mean 6.1 ± 5.4). These ED “clinical superusers” accounted for 7.7% (14,409) of total ED visits and underwent 6.8 ± 5.4 imaging examinations, while non-superusers underwent 1.5 ± 2.2 (p < 0.01). When ranked by ED imaging utilization, 12.3% (15,575) of patients underwent ≥ 4 ED imaging examinations and consumed 49.5% (95,053) of all imaging services. A subset of just 1.3% (1608) of ED patients underwent > 10 annual ED examinations (ED “imaging superusers”) and accounted for 12.4% (23,787) of all ED imaging services. Only 0.4% (n = 472) of patients were both clinical and imaging superusers. Despite similar ED visits to clinical superusers (6.0 ± 5.6 vs. 6.1 ± 5.4, p = 0.92), imaging superusers underwent significantly more imaging (14.8 ± 4.8 vs. 6.8 ± 5.4 examinations, p < 0.01).


Just 12% of ED patients consume 50% of all ED imaging services, and 1.3% consume 12.4%. These ED imaging superusers represent a distinct group from clinical superusers. Prospective identification of this newly described subgroup might permit targeted interventions to control ED imaging volume, restrain costs, and minimize per-patient radiation exposure.


Emergency department Radiology Utilization Imaging Superuser 


IRB statement

This study was reviewed and approved by our institutional IRB.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


MH and RD receive research support from the Harvey L. Neiman Health Policy Institute (Reston, VA). TNH is a 2017–2018 recipient of the American Society of Emergency Radiology Educational Grant.


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Copyright information

© American Society of Emergency Radiology 2018

Authors and Affiliations

  1. 1.Department of Radiology and Imaging SciencesEmory University School of MedicineAtlantaUSA
  2. 2.Division of Emergency and Trauma Imaging, Department of Radiology and Imaging SciencesEmory University Midtown HospitalAtlantaUSA
  3. 3.Department of Biostatistics and Bioinformatics, Rollins School of Public HealthEmory UniversityAtlantaUSA
  4. 4.Department of Health Policy and Management, Rollins School of Public HealthEmory UniversityAtlantaUSA
  5. 5.Department of Emergency MedicineEmory University School of MedicineAtlantaUSA

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