Abstract: Objective: To evaluate the appropriateness, requisition quality, and radiation exposure associated with emergency noncontrast abdominal-pelvic CT referrals, and to compare requisition quality across different appropriateness levels. Methods: In this retrospective study, five patients per day were randomly selected from a cohort of individuals who underwent emergency noncontrast abdominal-pelvic CT scans at a large tertiary hospital between 2025 August 01 and 2025 August 31. Only patients with complete clinical information, CT requisition forms, and radiation dose reports were included. Patients with missing or incorrect information or with inadequate image quality for radiation dose assessment were excluded. Scan appropriateness was assessed using the European Society of Radiology (ESR) iGuide tool, and requisition quality was evaluated using the Reason for Exam Imaging Reporting and Data System (RI-RADS) tool. Size-specific dose estimate (SSDE) and effective dose (ED) were calculated. For scans classified as inappropriate, imaging findings were reviewed to determine whether clinically significant positive results were present. Fisher's exact test was used to compare requisition quality across appropriateness levels. Results: A total of 150 patients were included, with a median age of 45.0 years (interquartile range IQR, 32.0–66.0 years); 84 patients (56.0%) were male. Twenty-eight scans (18.7%) were classified as usually inappropriate, 77 (51.3%) as appropriate, and 45 (30.0%) as usually appropriate. Requisition quality grades (A-D) were distributed as follows: 13 (8.7%), six (4.0%), 114 (76.0%), and 17 (11.3%). No statistically significant difference in requisition quality was observed across appropriateness levels (P = 0.131). Among the 28 usually inappropriate scans, the mean SSDE was 20.6±2.0 mGy, and the median ED was 8.1 (IQR, 6.8–9.4 mSv). Although positive findings were detected in some usually inappropriate scans, most were irrelevant to their request form. Conclusion: A proportion of emergency noncontrast abdominal-pelvic CT referrals are classified as usually inappropriate, potentially resulting in unnecessary radiation exposure. Overall, requisition quality was suboptimal and frequently insufficient to support emergency radiologic interpretation. However, no significant difference was observed in requisition quality across appropriateness levels. Clinicians should optimize the selection of emergency CT scans, improve requisition completion skills to minimize unnecessary radiation exposure, and enhance support for radiological diagnoses.