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A Cost-effectiveness Analysis Comparing a Clinical Decision Rule Versus Usual Care to Risk Stratify Children for Intraabdominal Injury After Blunt Torso Trauma

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      Most cited references 20

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      Computed tomography--an increasing source of radiation exposure.

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        Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer.

        Use of computed tomography (CT) for diagnostic evaluation has increased dramatically over the past 2 decades. Even though CT is associated with substantially higher radiation exposure than conventional radiography, typical doses are not known. We sought to estimate the radiation dose associated with common CT studies in clinical practice and quantify the potential cancer risk associated with these examinations. We conducted a retrospective cross-sectional study describing radiation dose associated with the 11 most common types of diagnostic CT studies performed on 1119 consecutive adult patients at 4 San Francisco Bay Area institutions in California between January 1 and May 30, 2008. We estimated lifetime attributable risks of cancer by study type from these measured doses. Radiation doses varied significantly between the different types of CT studies. The overall median effective doses ranged from 2 millisieverts (mSv) for a routine head CT scan to 31 mSv for a multiphase abdomen and pelvis CT scan. Within each type of CT study, effective dose varied significantly within and across institutions, with a mean 13-fold variation between the highest and lowest dose for each study type. The estimated number of CT scans that will lead to the development of a cancer varied widely depending on the specific type of CT examination and the patient's age and sex. An estimated 1 in 270 women who underwent CT coronary angiography at age 40 years will develop cancer from that CT scan (1 in 600 men), compared with an estimated 1 in 8100 women who had a routine head CT scan at the same age (1 in 11 080 men). For 20-year-old patients, the risks were approximately doubled, and for 60-year-old patients, they were approximately 50% lower. Radiation doses from commonly performed diagnostic CT examinations are higher and more variable than generally quoted, highlighting the need for greater standardization across institutions.
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          Methodologic standards for the development of clinical decision rules in emergency medicine.

           I Stiell,  G. Wells (1999)
          The purpose of this review is to present a guide to help readers critically appraise the methodologic quality of an article or articles describing a clinical decision rule. This guide will also be useful to clinical researchers who wish to answer 1 or more questions detailed in this article. We consider the 6 major stages in the development and testing of a new clinical decision rule and discuss a number of standards within each stage. We use examples from emergency medicine and, in particular, examples from our own research on clinical decisions rules for radiography in trauma.
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            Author and article information

            Affiliations
            [1 ]Department of Emergency Medicine; U.C. Davis School of Medicine; Sacramento CA
            [2 ]Center for Healthcare Policy and Research; U.C. Davis School of Medicine; Sacramento CA
            [3 ]Department of Pediatrics; U.C. Davis School of Medicine; Sacramento CA
            Journal
            Academic Emergency Medicine
            Acad Emerg Med
            Wiley
            10696563
            November 2013
            November 2013
            November 15 2013
            : 20
            : 11
            : 1131-1138
            10.1111/acem.12251
            (Editor)
            © 2013

            http://doi.wiley.com/10.1002/tdm_license_1.1

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            Self URI (article page): http://doi.wiley.com/10.1111/acem.12251

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