Impact of the COVID pandemic on emergency department CT utilization: where do we go from here?

Loftus, Timothy M.; Wessling, Emily G.; Cruz, Daniel S.; Schmidt, Michael; Kim, Howard; McCarthy, Danielle M.; Malik, Sanjeev

doi:10.1007/s10140-022-02071-z

Cited by 8 publications

(8 citation statements)

References 38 publications

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“…One of the most noticeable changes is the radiological imaging methods performed in the ED. During the pandemic, a significant increase in patients undergoing CCT was reported [14][15][16]. This increase is also evident in our study.…”

Section: Discussionsupporting

confidence: 83%

“…Due to the lung involvement of the virus, the number of patients undergoing thorax imaging increased significantly. During the pandemic, there was a significant increase in the number of patients who underwent CT imaging [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

“…With the restrictions and stay-at-home measures during the pandemic, there was a significant decrease in admissions to hospitals and EDs [17,18]. However, despite decreased ED visits and the fact that CXR helps diagnose and prognosis COVID-19, the number of CT imaging scans per patient increased considerably [14,19,20]. This increase is thought to be due to the increased diagnostic accuracy of CT imaging for COVID-19, increased risk of thromboembolism, increased rate of patients admitted by ambulance, and a higher rate of critical patient admissions to EDs [20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

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Have Chest Imaging Habits Changed in the Emergency Department after the Pandemic?

Arıkan,

Bora,

Kanter

et al. 2023

Tomography

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The rate of patients undergoing tomography in the emergency department has increased in the last two decades. In the last few years, there has been a more significant increase due to the effects of the pandemic. This study aimed to determine the rate of patients who underwent chest imaging in the emergency department, the preferred imaging method, and the demographic characteristics of the patients undergoing imaging during the pre-pandemic and post-pandemic periods. This retrospective cross-sectional study included patients admitted to the emergency department between January 2019 and March 2023. The number of female, male, and total emergency admissions, the rate of patients who underwent chest X-ray (CXR) and chest computed tomography (CCT), and the age and gender distribution of the cases who underwent chest imaging were compared according to the pre-pandemic (January 2019–February 2020), pandemic (March 2020–March 2022), and post-pandemic (April 2022–March 2023) periods. Total emergency admissions were similar in the pre-pandemic and post-pandemic periods (pre-pandemic period: 21,984 ± 2087; post-pandemic period: 22,732 ± 1701). Compared to the pre-pandemic period, the CCT rate increased (pre-pandemic period: 4.9 ± 0.9, post-pandemic period: 7.46 ± 1.2), and the CXR rate decreased (pre-pandemic period: 16.6 ± 1.7%, post-pandemic period: 13.3 ± 1.9%) in the post-pandemic period (p < 0.001). The mean age of patients who underwent chest imaging (CXR; Pre-pandemic period: 56.6 ± 1.1 years; post-pandemic period: 53.3 ± 5.6 years. CCT; Pre-pandemic period: 68.5 ± 1.7 years; post-pandemic period: 61 ± 4.0 years) in the post-pandemic period was lower than in the pre-pandemic period (p < 0.001). Chest imaging preferences in the emergency department have changed during the post-pandemic period. In the post-pandemic period, while younger patients underwent chest imaging in the emergency department, CCT was preferred, and the rate of CXR decreased. It is alarming for public health that patients are exposed to higher doses of radiation at a younger age.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Have Chest Imaging Habits Changed in the Emergency Department after the Pandemic?

Arıkan,

Bora,

Kanter

et al. 2023

Tomography

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“…Despite this, there was a significant increase in rates of chest CT utilization in ED following the start of the COVID pandemic, compared to pre-pandemic baseline [ 9 ]. It is desirable a stricter observation of the guidelines addressing new waves of this pandemic and/or future pandemics with the objective of avoiding inappropriate CT exams and of reducing infection risks [ 9 , 10 ].…”

Section: Typical Covid-19 Pneumonia Cxr Findings In Clinical Scenariosmentioning

confidence: 99%

Interpretation of chest radiography in patients with known or suspected SARS-CoV-2 infection: what we learnt from comparison with computed tomography

et al. 2022

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Differently from computed tomography (CT), well-defined terminology for chest radiography (CXR) findings and standardized reporting in the setting of known or suspected COVID-19 are still lacking. We propose a revision of CXR major imaging findings in SARS-CoV-2 pneumonia derived from the comparison of CXR and CT, suggesting a precise and standardized terminology for CXR reporting. This description will consider asymptomatic patients, symptomatic patients, and patients with SARS-CoV-2-related pulmonary complications. We suggest using terms such as ground-glass opacities , consolidation , and reticular pattern for the most common findings, and characteristic chest radiographic pattern in presence of one or more of the above-mentioned findings with peripheral and mid-to-lower lung zone distribution.

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“…Most indicators were from the USA (n = 18; 55%) and Ireland (n = 7; 21%). A A total of 14 indicators from 11 studies(46, 80, 85,92, 108,114,120,124,139,145,151) reported on the length of stay (LOS) in the ED, from which 11 (79%) indicators displayed a decreasing trend. Concerning the in-hospital LOS after ED admission, 8 indicators from 5 studies(121,124,133,137,153) were retrieved, from which 62% (n = 5) reported a decreasing trend.Concerning…”

mentioning

confidence: 99%

Acute care pathway assessed through performance indicators during the COVID-19 pandemic in OECD countries (2020-2021): a scoping review

Carvalho

Broekema

Fernandes

et al. 2023

Preprint

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Background: The COVID-19 pandemic severely impacted health systems, leading to care disruptions for non-COVID patients. Performance indicators to continuously monitor acute care, timely reported and internationally accepted, lacked during the COVID-19 pandemic in OECD countries. Methods: Scoping review. Search in Embase and MEDLINE databases. Acute care performance indicators were collected and collated following the care pathway; indicators related to acute general surgery were analyzed separately. Results: A total of 152 studies were included. 2354 indicators regarding general acute care and 301 indicators related to acute general surgery were collected and collated. Indicators focusing on pre-hospital services reported a decreasing trend in the volume of patients: from 225 indicators, 110 (49%) reported a decrease. An increasing trend in pre-hospital treatment times was reported by most of the indicators (n=41;70%) and a decreasing trend in survival rates of out-of-hospital cardiac arrest (n=61;75%). Concerning care provided in the emergency department, most of the indicators (n=752;71%) showed a decreasing trend in admissions, across all levels of urgency (n=26, 51% of highly urgent/level 1 indicators; n=20, 56% of level 2; n=31, 67% of level 3 and 4; and n=43, 78% of non-urgent/level 5 indicators). Indicators assessing the volume of diagnostic and treatment procedures signaled reductions: 65% (n=85) of the indicators and 51% (n=54) of the indicators, respectively. Concerning the mortality rate after admission, most of the indicators (n=23;53%) reported an increasing trend. The subset of indicators assessing acute general surgery showed a decreasing trend in the volume of patients reported by most of the indicators (n=50,49%), stability in clinical severity at admission (n=36,53%), and stability in the volume of surgeries (n=14,47%). Most of the indicators (n=28,65%) reported no change in treatment approach and stable mortality rate (n=11,69%). Conclusions: This review summarizes the performance indicators available in the literature to assess the quality of acute care in OECD countries and their trends during the first year and a half of the COVID-19 pandemic (2020-July2021). These results highlight the relevance of assessing the acute care pathway more regularly and systematically across different clinical entities, to monitor care disruptions and improve the resilience of emergency services to crises.

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Impact of the COVID pandemic on emergency department CT utilization: where do we go from here?

Cited by 8 publications

References 38 publications

Have Chest Imaging Habits Changed in the Emergency Department after the Pandemic?

Have Chest Imaging Habits Changed in the Emergency Department after the Pandemic?

Interpretation of chest radiography in patients with known or suspected SARS-CoV-2 infection: what we learnt from comparison with computed tomography

Acute care pathway assessed through performance indicators during the COVID-19 pandemic in OECD countries (2020-2021): a scoping review

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