Tourists more likely to undergo unnecessary imaging in the ED
New data suggest that tourists are significantly more likely to undergo unnecessary imaging in emergency situations.
Published in Emergency Radiology, the new findings highlight a trend among emergency departments in areas known to attract tourists. Although the study focused on a highly visited region of Italy, experts contend their work is widely applicable to other areas where hospitals frequently treat nonresident patients.
“Tourists are often exposed to unfamiliar environments, climates and physical activities, resulting in increased risks for trauma, infections and exacerbations of pre-existing conditions,” Carlo Cosimo Quattrocchi, with the department of radiology at Santa Maria del Carmine Hospital in Rovereto, and colleagues explained. “These patterns of care often differ from those of resident patients and raise important concerns about the scalability and adaptability of emergency services in touristic regions.”
For their work, the group retrospectively reviewed data on all ED visits that occurred in the Province of Trento between 2018 and 2024. Resident status, clinical data, including diagnostic imaging exams completed, and contextual information were all compared to determine whether tourist care differed from that of local patients.
Nearly 740,000 patient encounters were included in the analysis. Combined, these encounters resulted in almost 1.5 million imaging examinations. Nonresidents accounted for around 18% of ED visits during the time frame studied; approximately 20% of all imaging exams during the same time were attributed to tourist visits.
The team observed a positive correlation with nonresident status and the amount of imaging exams ordered during their visit, particularly for patients with red triage codes, who received four additional exams per encounter on average. Experts estimated that nonresidents had 32% greater odds of undergoing disproportionately high imaging volumes compared to locals.
Further analysis revealed that skeletal imaging was more common among nonresidents, potentially reflecting the traumatic nature of the injuries tourists might be more vulnerable to. Younger men also were statistically more likely to present with trauma-related injuries, the group noted.
“Together, these findings indicate that nonresident patients—particularly those in serious clinical condition—receive more extensive radiological assessment. A potential explanation is the limited clinical history available for nonresidents, which may prompt more comprehensive diagnostic imaging. Language barriers and communication challenges may also play a role in extending diagnostic procedures,” the authors suggested. “These factors could lead to a cautious approach by clinicians in order to minimize diagnostic uncertainty.”
To the team’s knowledge, their work is the first to provide evidence regarding the differential use of ED radiological services by residence status. They suggested their findings could be used to develop policies and protocols tailored to health systems in popular tourism regions.
“From an operational perspective, these findings have implications for staffing and resource planning in emergency radiology departments serving high-tourism regions,” the team noted, adding, “Radiology departments located near major tourist hubs may therefore benefit from adaptive staffing models that account for seasonal population fluctuations, including flexible scheduling of personnel during peak tourism periods.”
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In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.