Funding Research in Emergency Diagnostic Imaging: Summary of a Panel Discussion at the 2015 <i>Academic Emergency Medicine</i> Consensus Conference

Objective: Computed tomography (CT) imaging is frequently obtained for recurrent abdominal pain after a prior emergency department (ED) evaluation. We evaluate the utility of repeat CT imaging following an indeterminate index CT in low-risk abdominal pain adult ED patients.Methods: An electronic search was designed for the patient-intervention-controloutcome-timing (PICOT) question: (P) adult patients with low-risk, recurrent, and previously undifferentiated atraumatic abdominal pain presenting to the ED after an index-negative CT within 12 months; (I) repeat CT versus (C) no repeat CT; for (O) abdominal surgery or other invasive procedure, mortality, identification of potentially life-threatening diagnosis, and hospital and intensive care unit admission rates; and return ED visit (T), all within 30 days. Four reviewers independently selected evidence for inclusion and then synthesized the results around the most prevalent themes of repeat CT timing, diagnostic yield, ionizing radiation exposure, and predictors of repetitive imaging.Results: Although 637 articles and abstracts were identified, no direct evidence was found. Thirteen documents were synthesized as indirect evidence. None of the indirect evidence defined a low-risk subset of abdominal pain nor did investigators describe whether reimaging occurred for complaints similar to the initial ED evaluation.Included studies did not describe the index CT findings and some reported explanatory findings noted on the original CT for which repeat CTs might have been indicated.The time frame for a repeat CT ranged from hours to 1 year. The frequency of repeat CTs (2%-47%) varied across studies as did the yield of imaging to alter downstream clinical decision making (range = 5%-67%). Conclusion:Due to the absence of direct evidence our scoping review is unable to provide high-quality evidence-based recommendations upon which to confidently INTRODUC TI ONNontraumatic abdominal pain is the most common principal reason to visit an emergency department (ED) in the United States, representing 8.5% of visits based on data from the National Hospital Ambulatory Medical Care Survey (2018). 1 The frequency of repeat ED visits for "low-risk" and "undifferentiated" abdominal pain is unknown, but repeated visits for abdominal pain are common. In 2014, abdominal pain accounted for 15%-34% of all ED superutilizer visits, defined as patients with annual ED visits exceeding two standard deviations above the mean stratified by payer and age group. Among superutilizers, abdominal pain was the most common diagnosis in all age groups and payer types, with the sole exception of Medicareinsured patients aged 65 years and greater, in which it was the third most common diagnosis (Table 1). 2Computed tomography (CT) imaging for abdominal pain in the ED increased significantly over the past three decades. 3-5 CT often facilitates timely surgical diagnoses, excludes intraabdominal pathology, increases clinician and patient confidence in diagnosis, and can facilitate discharge rather than admiss...

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Repeat computed tomography in recurrent abdominal pain: An evidence synthesis for guidelines for reasonable and appropriate care in the emergency department

Carpenter

Griffey

Mills

et al. 2021

“…The second afternoon panel included representatives from the National Institutes of Health (Office of Emergency Care Research and National Institute of Biomedical Imaging and Bioengineering), the Patient‐Centered Outcomes Research Institute, and the Agency for Healthcare Research and Quality. Panelists discussed opportunities for funding at their agencies and strategies for successful grant applications …”

Section: Conference Planningmentioning

confidence: 99%

Developing a Research Agenda to Optimize Diagnostic Imaging in the Emergency Department: An Executive Summary of the 2015 Academic Emergency Medicine Consensus Conference

Marin

Mills

2015

Self Cite

The 2015 Academic Emergency Medicine (AEM) consensus conference, "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization," was held on May 12, 2015, with the goal of developing a high-priority research agenda on which to base future research. The specific aims of the conference were to: 1) understand the current state of evidence regarding emergency department (ED) diagnostic imaging utilization and identify key opportunities, limitations, and gaps in knowledge; 2) develop a consensus-driven research agenda emphasizing priorities and opportunities for research in ED diagnostic imaging; and 3) explore specific funding mechanisms available to facilitate research in ED diagnostic imaging. Over a 2-year period, the executive committee and other experts in the field convened regularly to identify specific areas in need of future research. Six content areas within emergency diagnostic imaging were identified prior to the conference and served as the breakout groups on which consensus was achieved: clinical decision rules; use of administrative data; patient-centered outcomes research; training, education, and competency; knowledge translation and barriers to imaging optimization; and comparative effectiveness research in alternatives to traditional computed tomography use. The executive committee invited key stakeholders to assist with planning and to participate in the consensus conference to generate a multidisciplinary agenda. There were 164 individuals involved in the conference spanning various specialties, including emergency medicine (EM), radiology, surgery, medical physics, and the decision sciences. This issue of AEM is dedicated to the proceedings of the 16th annual AEM consensus conference as well as original research related to emergency diagnostic imaging.

“…Although some evidence suggests that patients with LBP in the ED are appropriately imaged based on the American College of Radiology appropriateness criteria, other studies have reported that 30% of patients in which imaging for LBP was not indicated received imaging, suggesting substantial practice variation across EDs. Aligning imaging practices with appropriateness criteria is a primary goal of international campaigns such as Choosing Wisely and consensus‐based research agendas in emergency medicine . To support this goal, interventions to reduce image ordering among patients with LBP in both primary and acute care settings have been recommended.…”

mentioning

confidence: 99%

Effectiveness of Interventions to Decrease Image Ordering for Low Back Pain Presentations in the Emergency Department: A Systematic Review

Liu

Desai

Krebs

et al. 2018

While imaging of LBP has been identified as a key area of imaging overuse (e.g., Choosing Wisely recommendation), evidence on interventions to reduce image ordering for ED patients with LBP is sparse. There is some evidence to suggest that interventions can reduce the use of simple imaging in LBP in the ED; however, a shift in imaging modality has also been demonstrated. Additional studies employing higher-quality methods and measuring intervention fidelity are strongly recommended to further explore the potential of ED-based interventions to reduce image ordering for this patient population.