Background
Emergency Department imaging volume has increased significantly in North America and Asia.
Purpose
To assess Emergency Department imaging trends in a European center.
Material and Methods
The institutional radiological information system was queried for all computed tomography (CT), ultrasound (US), and magnetic resonance (MR) studies performed for the Emergency Department during 2002–2017. Descriptive statistics and linear regression analyses were used to assess overall study rates and temporal trends in overall and after-hours imaging after adjusting for patient visitations.
Results
CT use increased significantly from 38/1000 visits to 108/1000 at the end of the observation by 5.5 new exams per 1000 visits/year (
P
< 0.0001). US use increased gradually at a rate of 1.2/1000 per year during 2002–2008 with an accelerated annual increase of 6.4/1000 in 2009–2011 (
P
< 0.0001) raising US rates from 7/1000 to 28/1000 visits per year with stable rates from 2012 onwards. After on-site MR became available in 2004, its use increased from 0.3/1000 to 7/1000 at a rate of 1.9/1000 visits per year in 2005–2009 (
P
< 0.0001) and remained stable from 2010. While there was a significant increase in after-hours imaging, growth remained proportional to the overall trend in the use of CT, MR, and night-time CT with the exception of a slight decrease in after-hour US in favor of standard working hours (
P
< 0.0001).
Conclusion
All modalities increased significantly in volume adjusted usage. US and MR rates have been stable since 2012 and 2010, respectively, after periods of increase while CT use continues to increase. Demand for after-hours imaging was mostly proportional to the overall trend.
During the last decade the treatment of patients with acute myocardial infarction (AMI) has changed dramatically. In order to evaluate the overall impact of these changes on mortality and morbidity, we collected data on all patients hospitalized for AMI in Reykjavik, Iceland, during the calendar years of 1986 and 1996. Demographical characteristics of AMI patients did not change significantly between study periods. One-year mortality decreased from 26.3 to 19.7% (p < 0.05). Patients discharged with aspirin or β-antagonists as well as those who received thrombolytic therapy had decreased 1-year mortality both years. Patients discharged with diuretics, digoxin or antiarrhythmics had increased 1-year mortality. We conclude that the 25% reduction in 1-year mortality is partially due to changes in therapy.
The reduction in one-year mortality after myocardial infarction during the last two decades is explained by improved medical management with aspirin, beta-blockers and aggressive reperfusion therapy. Diuretic therapy, reflecting congestive heart failure, and increased age have negative effects on survival.
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