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      Trends in Computed Tomography Utilization and Association with Hospital Outcomes in a Chinese Emergency Department

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          Abstract

          Background

          Excessive use of computed tomography (CT) in emergency departments (EDs) has become a concern due to its expense and the potential risks associated with radiation exposure. Although studies have shown a steady increase in the number of CT scans requested by ED physicians in developed countries like the United States and Australia, few empirical data are available regarding China.

          Methods and Findings

          We retrospectively analyzed a database of ED visits to a tertiary Chinese hospital to examine trends in CT utilization and their association with ED outcomes between 2005 and 2008. A total of 197,512 ED visits were included in this study. CT utilization increased from 9.8% in 2005 to 13.9% in 2008 ( P<.001 for trend). The ED length of stay for visits with CT utilization was 0.6 hour longer than those in which CT was not obtained. CT utilization increased the ED cost by an average $48.2. After adjustment for patients’ demographics, arrival hours and clinical condition, CT utilization during ED visits was significantly associated with high ED cost (Odds Ratio [OR]: 21.70; 95% confidence interval [CI], 17.00–27.71), long ED length of stay (OR: 1.22; 95%CI, 1.12–1.34), and more likely to receive emergency operations (OR: 2.31; 95%CI, 1.94–2.76). However, there was no significant correlation between CT use and the possibility to be admitted to inpatient wards (OR: 0.82; 95%CI, 0.65–1.04). With respect to the time-related trends, CT utilization during ED visits in all study years was significantly associated with high ED cost and more likely to receive emergency operations.

          Conclusion

          CT utilization was associated with higher ED cost, longer ED length of stay and more likely to receive emergency operations, but did not correlate with a significant change in the admission rate.

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          Most cited references16

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          Indications for computed tomography in patients with minor head injury.

          M J Haydel, C Preston, T. J. Mills … (2000)
          Computed tomography (CT) is widely used as a screening test in patients with minor head injury, although the results are often normal. We performed a study to develop and validate a set of clinical criteria that could be used to identify patients with minor head injury who do not need to undergo CT. In the first phase of the study, we recorded clinical findings in 520 consecutive patients with minor head injury who had a normal score on the Glasgow Coma Scale and normal findings on a brief neurologic examination; the patients then underwent CT. Using recursive partitioning, we derived a set of criteria to identify all patients who had abnormalities on CT scanning. In the second phase, the sensitivity and specificity of the criteria for predicting a positive scan were evaluated in a group of 909 patients. Of the 520 patients in the first phase, 36 (6.9 percent) had positive scans. All patients with positive CT scans had one or more of seven findings: headache, vomiting, an age over 60 years, drug or alcohol intoxication, deficits in short-term memory, physical evidence of trauma above the clavicles, and seizure. Among the 909 patients in the second phase, 57 (6.3 percent) had positive scans. In this group of patients, the sensitivity of the seven findings combined was 100 percent (95 percent confidence interval, 95 to 100 percent). All patients with positive CT scans had at least one of the findings. For the evaluation of patients with minor head injury, the use of CT can be safely limited to those who have certain clinical findings.
          Article 0 comments Cited 189 times – based on 0 reviews     Review now
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            Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study.

            Stefan Huber-Wagner, Rolf Lefering, Lars-Mikael Qvick … (2009)
            The number of trauma centres using whole-body CT for early assessment of primary trauma is increasing. There is no evidence to suggest that use of whole-body CT has any effect on the outcome of patients with major trauma. We therefore compared the probability of survival in patients with blunt trauma who had whole-body CT during resuscitation with those who had not. In a retrospective, multicentre study, we used the data recorded in the trauma registry of the German Trauma Society to calculate the probability of survival according to the trauma and injury severity score (TRISS), revised injury severity classification (RISC) score, and standardised mortality ratio (SMR, ratio of recorded to expected mortality) for 4621 patients with blunt trauma given whole-body or non-whole-body CT. 1494 (32%) of 4621 patients were given whole-body CT. Mean age was 42.6 years (SD 20.7), 3364 (73%) were men, and mean injury-severity score was 29.7 (13.0). SMR based on TRISS was 0.745 (95% CI 0.633-0.859) for patients given whole-body CT versus 1.023 (0.909-1.137) for those given non-whole-body CT (p<0.001). SMR based on the RISC score was 0.865 (0.774-0.956) for patients given whole-body CT versus 1.034 (0.959-1.109) for those given non-whole-body CT (p=0.017). The relative reduction in mortality based on TRISS was 25% (14-37) versus 13% (4-23) based on RISC score. Multivariate adjustment for hospital level, year of trauma, and potential centre effects confirmed that whole-body CT is an independent predictor for survival (p
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              Cancer risks from diagnostic radiology.

              Daniel Hall, Eric Brenner (2008)
              In recent years, there has been a rapid increase in the number of CT scans performed, both in the US and the UK, which has fuelled concern about the long-term consequences of these exposures, particularly in terms of cancer induction. Statistics from the US and the UK indicate a 20-fold and 12-fold increase, respectively, in CT usage over the past two decades, with per caput CT usage in the US being about five times that in the UK. In both countries, most of the collective dose from diagnostic radiology comes from high-dose (in the radiological context) procedures such as CT, interventional radiology and barium enemas; for these procedures, the relevant organ doses are in the range for which there is now direct credible epidemiological evidence of an excess risk of cancer, without the need to extrapolate risks from higher doses. Even for high-dose radiological procedures, the risk to the individual patient is small, so that the benefit/risk balance is generally in the patients' favour. Concerns arise when CT examinations are used without a proven clinical rationale, when alternative modalities could be used with equal efficacy, or when CT scans are repeated unnecessarily. It has been estimated, at least in the US, that these scenarios account for up to one-third of all CT scans. A further issue is the increasing use of CT scans as a screening procedure in asymptomatic patients; at this time, the benefit/risk balance for any of the commonly suggested CT screening techniques has yet to be established.
              Article 0 comments Cited 136 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                : Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, USA )
                ISSN (Electronic): 1932-6203
                Publication date Collection: 2012
                Publication date (Electronic): 12 July 2012
                Volume: 7
                Issue: 7
                Electronic Location Identifier: e40403
                Affiliations
                [1 ]Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
                [2 ]Department of Biomedical Informatics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
                [3 ]Department of Epidemiology and Health Statistics, College of Public Health, Zhejiang University, Hangzhou, Zhejiang, China
                [4 ]Vallejo, California, United States of America
                [5 ]Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
                [6 ]Department of Infectious Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
                Yale University School of Medicine, United States of America
                Author notes

                Conceived and designed the experiments: JCZ KR. Performed the experiments: JCZ SWZ CWJ. Analyzed the data: JCZ SWZ YXY KR YSY. Contributed reagents/materials/analysis tools: DYZ KHP YSY. Wrote the paper: JCZ KR. Contributed to the design and interpretation of results: YXY WLJ DYZ KHP YSY.

                Article
                Publisher ID: PONE-D-11-13936
                DOI: 10.1371/journal.pone.0040403
                PMC ID: 3395702
                PubMed ID: 22808154
                SO-VID: 15a08fb3-ae55-40e2-a325-f83b92b208c8
                Copyright © Zhou et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
                History
                Date received : 22 July 2011
                Date accepted : 8 June 2012
                Page count
                Pages: 6
                Categories
                Subject: Research Article
                Subject: Biology
                Subject: Biophysics
                Subject: Radiation Biophysics
                Subject: Radiation Exposure
                Subject: Medicine
                Subject: Clinical Research Design
                Subject: Epidemiology
                Subject: Retrospective Studies
                Subject: Statistical Methods
                Subject: Critical Care and Emergency Medicine
                Subject: Non-Clinical Medicine
                Subject: Health Care Policy
                Subject: Health Risk Analysis
                Subject: Health Care Quality
                Subject: Public Health
                Subject: Occupational and Industrial Health
                Subject: Preventive Medicine
                Subject: Radiology
                Subject: Diagnostic Radiology
                Subject: Computed Tomography
                Subject: Social and Behavioral Sciences
                Subject: Economics
                Subject: Human Capital
                Subject: Economics of Health
                Subject: Health Economics
                Subject: Sociology
                Subject: Demography

                ScienceOpen disciplines: Uncategorized
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                ScienceOpen disciplines: Uncategorized

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