Introduction:

Computed tomography (CT) is a fundamental diagnostic tool. However, its increasing use raises questions about the appropriateness of requests and the actual clinical impact of the examinations. International literature describes variability in appropriateness and highlights the importance of standardising the clinical indication as a determinant of diagnostic value.

Objective:

To describe the institutional use of CT in the emergency department, assess the appropriateness of 300 consecutive requests, analyse the actual clinical impact through the audit of 60 clinical episodes, and identify independent predictors of diagnostic yield.

Methods:

Mixed observational study comprising: (1) institutional analysis of the annual CT volume (August 2024–July 2025); (2) audit of diagnostic appropriateness in 300 CT requests; and (3) assessment of the actual clinical impact through the review of 60 medical records. Anatomical region, priority, consultation modality, standardisation of the clinical indication, and expected and actual clinical impacts were analysed. Bivariate analyses and a multivariate logistic regression model were applied.

Results:

A total of 4,541 CT scans were performed among 115,530 consultations (3.93%). Cranial CT accounted for 43% of requests; standardisation of the clinical indication was lower for neuroimaging (47.3%) than for chest and abdominal examinations (>90%); and the expected clinical impact was significantly higher for chest and abdominal CT (p = 0.022). High actual clinical impact reached 76.7%, with moderate agreement between expected and actual impact (κ = 0.36). Standardisation of the clinical indication (aOR 2.80) and chest and abdominal regions (aOR 2.30 and 4.10, respectively) were independent predictors of high actual impact, whereas consultation with specialists showed no significant association.

Conclusions:

The use of CT in the emergency department is characterised by moderate frequency, an anatomical distribution comparable to that described in international literature, and adequate clinical yield. Standardisation of the clinical indication emerges as a key factor in maximising diagnostic value and reducing variability. Interventions aimed at improving the quality of requests, rather than increasing authorisation mechanisms, could optimise the clinical impact of CT in emergency care.

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