When More is Less: Re-Examining CTA Use in GI Bleeds

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Gastrointestinal bleeding (GIB) is a frequent and potentially life-threatening emergency that requires timely diagnosis and management. Computed tomographic angiography (CTA) has become a first-line diagnostic tool for suspected GIB due to its high sensitivity and specificity. However, the growing use of CTA in emergency departments (EDs) raises concerns about overuse, increased costs, radiation exposure, and interpretation burden—particularly if diagnostic yield (the proportion of positive scans) is declining.

THE PODCAST

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. doi:10.1001/jamanetworkopen.2025.29746

Summary

Methods

This retrospective cohort study was conducted at a 1011-bed urban academic medical center between January 2017 and December 2023.

  • Population: Adult ED patients (≥18 years) who underwent abdominal and/or pelvic CTA for suspected GIB.

  • Outcomes:

    • Annual volume and proportion of GIB-related CTA exams among all ED CTs.

    • Diagnostic yield—the percentage of CTAs showing active bleeding or evidence of hemorrhage.

  • Analysis: Trends were assessed using linear regression. Logistic regression identified factors associated with test-positive studies.

Results

  • Sample size: 954 patients (mean age 66.7 years; 45% female).

  • CTA utilization: Increased from 30 studies (0.09% of all ED CTs) in 2017 to 288 (0.7%) in 2023, an annual increase of 0.09% (95% CI, 0.07% to 0.12%; p < .001)

  • Diagnostic yield: Decreased from 20.0% in 2017 to 6.3% in 2023 (annual decrease, –1.60%; 95% CI, –2.41% to –0.79%; p = .001)

  • Associations:

    • Older age → higher odds (OR 1.02; 95% CI, 1.00-1.04; p = .02).

    • Active cancer → lower odds (OR 0.35; 95% CI, 0.12-1.00; p = .05).

Overall, more CTAs were being ordered, but fewer were positive for bleeding.

Conclusions

CTA use for suspected GI bleeding in the ED has increased sharply over the past seven years, while its diagnostic yield has declined. These findings suggest potential overuse of CTA in evaluating suspected GIB. The study underscores the need for evidence-based imaging criteria and decision-support tools to optimize CTA utilization and reduce unnecessary imaging.

Limitations

  • Single-center academic setting limits generalizability.

  • Retrospective design with limited clinical and outcome data (e.g., no assessment of downstream management or alternative findings).

  • No inter-rater reliability testing among radiologists.

Final Recommendations

  • Clinicians should apply guideline-based criteria before ordering CTA for suspected GI bleeding, prioritizing patients with hemodynamically instability or active bleeding.

  • Institutions should implement decision-support tools to encourage high-value imaging.

  • Future research should evaluate clinical outcomes and cost-effectiveness of CTA in GIB workups across multiple centers.

AUTHORSHIP

Written by: Jessica Guillaume, MD, PGY-3 University of Cincinnati Department of Emergency Medicine

Editing, Posting, and Audio Editing by Anita Goel, MD Adjunct Associate Professor, University of Cincinnati Department of Emergency Medicine.

Cite as: Guillaume, J., Goel, A. When More is Less: Re-Examining CTA Use in GI Bleeds. TamingtheSRU.com. www.tamingthesru.com/blog/journal-club-diagnostic-yield-of-ct-angiography-for-gi-bleeding. 11/12/2025.