Avoid Unnecessary Treatments in the ER

A discussion with the doctor can help you make the best decision

It can be hard to say “No” in the emergency department. But talking with your emergency room (ER) doctor may help you avoid costly testing.

That’s why the American College of Emergency Physicians lists three common procedures you should know about:

  • CT scans of the head for minor injury
  • Urinary catheters
  • Antibiotics and cultures for abscesses

CT scans of the head for minor injury.

A CT scan uses X-rays to create a picture of the brain. If your head injury is not serious, a CT scan does not give useful information to the doctor. A medical history and physical exam help the doctor determine if your injury is minor. This can help you avoid a CT scan.

CT scans have risks and cost a lot.
CT scans use radiation, which can increase the risk of cancer. Children, especially infants, have greater risks because their brains are still developing.

Services in the ER cost a lot, because of fees for doctors, services, and facilities. A CT scan can add over $2,000 to your costs.

You may need a CT scan if you have dangerous symptoms, such as:

  • An injury your doctor can see or feel.
  • Becoming unconscious.
  • Changes in mental state or alertness.
  • Ongoing vomiting or a bad headache.

If you take a blood thinner, such as warfarin (Coumadin®), you are more likely to bleed. So you may need a CT scan, even for a minor injury.

Urinary catheters

This is a tube put into the bladder for urinating. It may be called a “Foley” (indwelling) catheter.

A catheter can be convenient, but the risks can be greater than the benefits.

Catheters have risks and costs. Catheters increase the risk of a urinary tract infection, which can injure the urethra and kidneys. The chance of infection is higher after just three days of use. Treatment can cost over $1,000. Other follow-up care, with longer hospital stays, can cost much more.

You usually need a Foley catheter if you:

  • Can’t urinate, after trying a few times.
  • Are very ill, and they need to check how much urine you make.
  • Have an operation on your urinary system.
  • Have pain with urination in end-of-life care. Even then, there are other solutions, like condom catheters for men.

Antibiotics and cultures for abscesses.

Millions of Americans go to ERs for abscesses— infections of pus below the skin. Doctors usually drain the abscess with a cut through the skin.

After the ER visit, you need to take care of your wound. Usually it heals on its own without antibiotics. And usually you don’t need a culture. This is just a lab test to see what caused the infection.

Risks and costs of cultures and antibiotics.

A culture isn’t risky, but it can cost $100 or more. Antibiotics can cause “resistance.” This means that antibiotics won’t work as well when you really need them in the future. There can also be side effects, such as an allergic reaction or diarrhea. Treating resistant infections and side effects can be costly.

You may need antibiotics if you:

  • Have a weak immune system. For example, you have diabetes or HIV/AIDS, or you are in chemotherapy.
  • Have an abscess that has been drained but is not healing quickly or has come back.

This report is for you to use when talking with your health-care provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

© 2014 Consumer Reports. Developed in cooperation with the American College of Emergency Physicians.