Increased Computed Tomography Utilization in the Emergency Department and Its Association with Hospital Admission

Bellolio, M. Fernanda; Heien, Herbert C.; Sangaralingham, Lindsey R.; Jeffery, Molly Moore; Campbell, Ronna L.; Cabrera, Daniel; Shah, Nilay D.; Hess, Erik P.

doi:10.5811/westjem.2017.5.34152

Cited by 111 publications

(78 citation statements)

References 55 publications

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“…Though several observational studies have assessed the value of such tools at potentially reducing unnecessary CTH [ 2 ], it is not clear that such efforts have led to reduction in CTH usage. Rather, data suggest that CTH use in emergency departments is increasing [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Rate of Intracranial Hemorrhage After Minor Head Injury

Bonney¹,

Briggs²,

Briggs³

et al. 2020

Cureus

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Introduction: Computed tomography scans of the head (CTH) are an important component of the initial patient evaluation after blunt head trauma in select patients. Here we review findings of CTH performed for mild traumatic brain injury (TBI) at a Level I trauma center over a two-year period. We subsequently discuss the role and limitations of published clinical decision rules aiming to decrease unnecessary CTH in mild TBI patients. Methods: We reviewed all Emergency Department CTH obtained after blunt head trauma between 2010 and 2011. Patient demographics and radiology report texts were collected. Reports were cross-referenced with our institutional trauma database to obtain initial Glasgow Coma Scale (GCS). Mild TBI was defined by an initial GCS 13-15 with or without loss of consciousness or post-traumatic amnesia. Results: There were 5,634 mild TBI patients evaluated with CTH. A total of 477 scans (8.5%) were positive for intracranial hemorrhage. Of these, 188 (39.4%) showed more than one type of intracranial hemorrhage. The most common findings were subdural hematomas (262, 4.7% of scans), traumatic subarachnoid hemorrhages (252, 4.5% of scans), and cerebral contusions/intraparenchymal hematomas (212, 3.8% of scans). Older age (p<0.001) and male gender (p<0.001) were associated with positive CTH. Conclusions: The rate of positive CTH in mild TBI patients in our population falls within a historical range. The clinical and medicolegal implications of missed intracranial hemorrhage have remained important factors limiting the implementation of clinical decision rules in screening mild TBI patients for CTH.

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Section: Introductionmentioning

confidence: 99%

Rate of Intracranial Hemorrhage After Minor Head Injury

Bonney¹,

Briggs²,

Briggs³

et al. 2020

Cureus

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“…Several studies have shown that ED imaging volume decreased substantially during the COVID-19 pandemic [3,4,6]. This contrasts with the pre-pandemic trend in ED imaging, particularly CT, which had been increasing for the past decade [14][15][16], as convincing data has shown that early CT diagnosis of certain conditions, such as appendicitis and uncomplicated diverticulitis, reduces hospital resource use and improves patient outcomes [17,18]. There are several potential reasons why ED CT volume decreased during the COVID-19 pandemic, as one would expect the incidence of diseases requiring an abdominopelvic CT in the ED should remain constant or increased.…”

Section: Discussionmentioning

confidence: 97%

Impact of the COVID-19 pandemic on emergency department CT for suspected diverticulitis: A natural experiment to explain patients’ and clinicians’ assessment of risk and willingness to undergo CT scanning?

Gibson

Chen

Rosen

et al. 2020

Preprint

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Purpose: This study examined the impact of the COVID-19 pandemic on emergency department CT use for acute non-traumatic abdominal pain, to better understand why imaging volume so drastically decreased during the COVID-19 pandemic.Methods: This was a retrospective review of emergency imaging volumes from January 5 to May 30, 2020. Weekly volume data were collected for total imaging studies, abdominopelvic CT, and abdominopelvic CTs positive for common causes of acute non-traumatic abdominal pain. Two emergency radiology attendings scored all diverticulitis cases independently and weekly volume data for uncomplicated and complicated diverticulitis cases was also collected. Volume data prior to and during the COVID-19 pandemic was compared, using 2019 volumes as a control.Results: During the COVID-19 pandemic, overall emergency imaging volume decreased 30% compared to 2019 (p = 0.002). While the number of emergency abdominopelvic CTs positive for appendicitis and small bowel obstruction did not significantly change during the COVID-19 pandemic, the number of cases of diverticulitis decreased significantly compared to 2019 (p = 0.001). This reduction can be specifically attributed to decreased uncomplicated diverticulitis cases, as the number of uncomplicated diverticulitis cases dropped significantly (p = 0.002) while there was no significant difference in the number of complicated diverticulitis cases (p = 0.09). Conclusions: Reduced emergency abdominopelvic CT volume during the COVID-19 pandemic can partially be explained by decreased imaging of lower acuity patients. This data may help formulate future strategies for imaging resource utilization with an improved understanding of the relationship between perceived imaging risk and symptom acuity.

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“…Other potential reasons may be an improvement of existing imaging technology, fear of litigation, or change of institutional culture, for example attitudes towards risk of missing diagnoses. Because of the increasing number of patients and the increase in the use of imaging [ 26 , 27 ], efficient use of CT scanning is now more required than ever [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of guidelines for the management of minor head injury on the utilization and diagnostic yield of CT over two decades, using natural language processing in a large dataset

et al. 2019

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Objectives We investigated the impact of clinical guidelines for the management of minor head injury on utilization and diagnostic yield of head CT over two decades. Methods Retrospective before-after study using multiple electronic health record data sources. Natural language processing algorithms were developed to rapidly extract indication, Glasgow Coma Scale, and CT outcome from clinical records, creating two datasets: one based on all head injury CTs from 1997 to 2009 ( n = 9109), for which diagnostic yield of intracranial traumatic findings was calculated. The second dataset (2009–2014) used both CT reports and clinical notes from the emergency department, enabling selection of minor head injury patients ( n = 4554) and calculation of both CT utilization and diagnostic yield. Additionally, we tested for significant changes in utilization and yield after guideline implementation in 2011, using chi-square statistics and logistic regression. Results The yield was initially nearly 60%, but in a decreasing trend dropped below 20% when CT became routinely used for head trauma. Between 2009 and 2014, of 4554 minor head injury patients overall, 85.4% underwent head CT. After guideline implementation in 2011, CT utilization significantly increased from 81.6 to 87.6% ( p = 7 × 10 −7 ), while yield significantly decreased from 12.2 to 9.6% ( p = 0.029). Conclusions The number of CTs performed for head trauma gradually increased over two decades, while the yield decreased. In 2011, despite implementation of a guideline aiming to improve selective use of CT in minor head injury, utilization significantly increased. Key Points • Over two decades, the number of head CTs performed for minor, moderate, and severe head injury gradually increased, while the diagnostic yield for intracranial findings showed a decreasing trend. • Despite the implementation of a guideline in 2011, aiming to improve selective use of CT in minor head injury, utilization significantly increased, while diagnostic yield significantly decreased. • Natural language processing is a valuable tool to monitor the utilization and diagnostic yield of imaging as a potential quality-of-care indicator. Electronic supplementary material The online version of this article (10.1007/s00330-018-5954-5) contains supplementary material, which is available to authorized users.

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Increased Computed Tomography Utilization in the Emergency Department and Its Association with Hospital Admission

Cited by 111 publications

References 55 publications

Rate of Intracranial Hemorrhage After Minor Head Injury

Rate of Intracranial Hemorrhage After Minor Head Injury

Impact of the COVID-19 pandemic on emergency department CT for suspected diverticulitis: A natural experiment to explain patients’ and clinicians’ assessment of risk and willingness to undergo CT scanning?

Impact of guidelines for the management of minor head injury on the utilization and diagnostic yield of CT over two decades, using natural language processing in a large dataset

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