Emergency radiology demand in a touristic region: residence status as a driver of imaging use

Purpose: To assess whether residence status influences the use of radiological services in emergency departments (EDs) in a high-tourism region of Northern Italy. Methods: This retrospective study analyzes all ED visits in the Autonomous Province of Trento from January 1, 2018 to December 31, 2024. Patients were categorized as residents or non-residents based on municipality of residence. Demographic, clinical, and contextual variables were extracted from the ED database. Regression models (OLS, Poisson, negative binomial, and logistic) were applied to evaluate determinants of radiological examination volume and workload, and the impact of residence status, including interaction with triage priority codes. Results: The sample includes 738,864 patients who underwent at least one radiological examination (overall volume of 1,474,937 imaging examinations). Non-residents accounted for 18.2% of patients and 20% of all radiological examinations. On average, they underwent significantly more imaging per visit than residents (2.19 vs. 1.95), even after controlling for confounding variables. Differences were most pronounced in high-priority cases: non-residents with red triage codes received nearly four additional examinations. Skeletal imaging was particularly over-represented among non-residents, consistent with trauma-related visits during tourism. Logistic regression showed non-residents had 31.9% higher odds of undergoing disproportionately high imaging volumes. Conclusion: Residence status significantly influences diagnostic imaging use in emergency settings. Non-residents, particularly in severe clinical conditions, undergo more extensive radiological evaluation. This likely reflects diagnostic uncertainty and lack of prior medical history. Findings underscore the need for adaptive resource planning in touristic areas and call for further studies on clinical appropriateness and outcome impact.