Category: Gastrointestional
Keywords: GI bleed, imaging (PubMed Search)
Posted: 9/10/2025 by Neeraja Murali, DO, MPH
(Updated: 12/5/2025)
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The TLDR:
In the ED setting, CTA for suspected GI bleeding is frequently ordered, but it’s finding less. At one center, use went up sevenfold over six years, while positive results dropped from 1 in 5 scans to about 1 in 16. Older patients are more likely to have a positive scan, and those with active cancer less so. CTA can be very useful when targeted, but widespread use may add cost, radiation, and crowding without improving care—so choosing patients carefully is key.
The longer version:
This was a retrospective cohort study involving adult patients who had undergone abdominal and pelvic CTA for suspected GIB at a large urban academic medical center between January 2017 and December 2023. The primary outcomes of interest were 1) The annual number and proportion of GIB-related CTAs among all CT scans performed in the ED, and 2) The diagnostic yield, defined as the percentage of CTAs that showed active bleeding or hemorrhage.
Findings:
CTA usage increased substantially: In 2017, there were 30 GIB-related CTAs out of 32,197 ED CT exams (0.09%). By 2023, this rose to 288 out of 44,423 (0.65%)
Diagnostic yield declined: In 2017, 6 of 30 CTAs were positive (20.0%). In 2023, only 18 of 288 were positive (6.3%)
Data of interest:
Later years (ie 2023 rather than 2017) were linked to lower odds of a positive CTA (odds ratio [OR] 0.84 per year; 95% CI, 0.73–0.96; P = .01). Older patients had higher odds of a positive result (OR 1.02 per year of age; 95% CI, 1.00–1.04; P = .02). Patients with active cancer had lower odds of positive findings (OR 0.35; 95% CI, 0.12–1.00; P = .05)
Discussion:
Despite the marked increase in CTA use for suspected GIB, its diagnostic effectiveness dropped sharply over the study period. The findings emphasize the need to balance the benefits (such as detecting active bleeding) with the downsides—including interpretation time, radiation exposure, costs, and ED crowding. The authors suggest implementing evidence-based protocols and decision-support tools to optimize CTA use in emergency settings to improve appropriateness and diagnostic yield.
Prasad S, Hood CM, Young C, et al. Computed Tomographic Angiography and Yield for Gastrointestinal Bleeding in the Emergency Department. JAMA Netw Open. 2025;8(8):e2529746. Published 2025 Aug 1. doi:10.1001/jamanetworkopen.2025.29746
