Pattern of Emergent Chest Computed Tomography Findings in a Tertiary Care Hospital during Off-Working Hours: Retrospective Analysis

Abstract Background and Objective: With the increasing accessibility of advanced imaging facilities in healthcare settings, the utilization of urgent computed tomography (CT) examinations has risen substantially, particularly during off-working hours when emergency medical services are in high demand. This study aims to comprehensively analyze the pattern, indications, and diagnostic outcomes of emergent CT chest studies performed during off-working hours at a tertiary care teaching hospital in western India, with particular emphasis on identifying common clinical presentations and the diagnostic yield of these urgent imaging procedures. Methodology: This retrospective observational study was conducted by systematically collecting and analyzing patient data from the hospital information system (HIS) and electronic medical records (EMR). The study population comprised all patients who underwent urgent CT chest examinations during off-working hours over the specified study period. Data extraction included patient demographics (age, gender), clinical indications for imaging, imaging protocols utilized, and radiological findings. Statistical analysis methods were employed to evaluate the distribution of patient characteristics, frequency of various clinical presentations, and correlation between clinical indications and imaging outcomes. For patients undergoing CT pulmonary angiography (CTPA), the Wells’ scoring system—a validated clinical decision tool for assessing the pre-test probability of pulmonary thromboembolism—was applied to stratify risk categories and guide imaging decisions. This systematic approach allowed for objective evaluation of the diagnostic yield and clinical utility of urgent chest imaging in the emergency setting. Results and Findings: A total of 143 patients underwent urgent CT chest studies during off-working hours, with 87 males (60.8%) and 56 females (39.2%), yielding a mean age of 56.25 years. Respiratory symptoms including chronic cough, acute dyspnea, hemoptysis, and productive cough constituted the predominant clinical indications for imaging. Notably, the majority of CT examinations did not reveal significant pathological findings. Among the 13 CTPA studies performed, 5 cases (38.5%) demonstrated pulmonary thromboembolism, including four acute cases and one chronic case, representing a relatively high positivity rate attributable to the pre-imaging application of Wells’ scoring system for risk stratification. Conclusion: Active infectious pathology emerged as the most common positive finding on urgent CT chest examinations, while a substantial proportion of studies yielded negative results without significant lung parenchymal abnormalities. The implementation of clinical decision-making tools, particularly Wells’ scoring prior to CTPA, demonstrated effectiveness in improving diagnostic yield for pulmonary thromboembolism detection in the emergency setting.