Emergency Department Computed Tomography Utilization in the United States and Canada
Emergency Department Computed Tomography Utilization in the United States and Canada
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DOI：
10.1016/j.annemergmed.2013.02.018
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发表时间：
2013-11-01
影响因子：
6.2
通讯作者：
Schull, Michael J.
中科院分区：
文献类型：
--
作者：
Berdahl, Carl T.;Vermeulen, Marian J.;Schull, Michael J.
研究目的：我们比较长期的趋势，在美国和安大略，加拿大的急诊科（ED）的计算机断层扫描（CT）的利用率：方法：在美国（全国医院门诊医疗保健调查）和行政数据库在安大略，我们进行了一项回顾性研究，从2003年至2008年的艾德访问。我们根据访视特征计算了总体利用率，并针对CT通常适用的5种临床状况：腹痛、复杂性腹痛（腹痛、年龄、紧急至最紧急分诊）、入院复杂性腹痛（腹痛、年龄、紧急至最紧急分诊和入院）、头痛和胸痛/呼吸短促。美国的数据进行了加权，以产生国家estimations.Results：现场CT可为97%（95%置信区间[CI] 95%至99%）的访问，在美国相比，80%（95% CI 80%至80%），在安大略。在美国，与安大略相比，更频繁地将访视分类为高敏度，15.1%（95% CI 13.9%至16.4%）的美国访视被归类为最紧急，而安大略的这一比例为11.8%（95% CI 11.8%至11.8%）。在美国进行CT检查的所有艾德访视比例为11.4%（95% CI 10.8%-12.0%），而在安大略为5.9%（95% CI 5.9%-5.9%）。美国儿童的比例为4.7%（95% CI 4.3%-5.1%），而安大略为1.4%（95% CI 1.4%-1.4%）。2003年至2008年，美国（比值比2.00; 95% CI 1.81至2.21）每年CT就诊率的增长速度快于安大略（比值比1.69; 95% CI 1.68至1.70）。随着时间的推移，除了10岁以下的安大略儿童CT率显著下降外，所有亚组的CT率都有所增加。美国安大略地区头痛、腹痛、胸痛/呼吸短促和复杂腹痛患者的CT比例差异显著。两个司法管辖区涉及入院复杂腹痛的就诊比例无法区分：美国为45.8%（95% CI 39.9%至51.7%）vs 44.7%（95%置信区间为44.4%至45.0%）。CT在美国急诊科更容易获得，美国临床医生比他们在安大略的同事更频繁地使用该技术治疗几乎所有类别的患者，包括儿童。随着时间的推移，两个司法管辖区的CT使用率都有所增加，但在美国更快。两个司法管辖区之间的不同人口统计学特征，包括分流严重程度，住院频率和CT扫描仪的可用性，可能至少部分解释了CT利用率的差异。调查美国和加拿大之间CT使用差异的临床和非临床原因将是一个富有成果的领域，需要进一步研究。
Study objective: We compare secular trends in computed tomography (CT) utilization in emergency departments (EDs) in the United States and Ontario, Canada.Methods: Using a systematic survey in the US (The National Hospital Ambulatory Medical Care Survey) and administrative databases in Ontario, we performed a retrospective study of ED visits from 2003 to 2008. We calculated utilization overall, by visit characteristics, and for 5 clinical conditions in which CT is commonly indicated: abdominal pain, complex abdominal pain (abdominal pain, age years, urgent to most urgent triage), admitted complex abdominal pain (abdominal pain, age years, urgent to most urgent triage, and admitted to hospital), headache, and chest pain/shortness of breath. US data were weighted to produce national estimates.Results: On-site CT was available for 97% (95% confidence interval [Cl] 95% to 99%) of visits in the United States compared with 80% (95% Cl 80% to 80%) in Ontario. Visits were more frequently triaged as higher acuity in the United States than in Ontario, with 15.1% (95% Cl 13.9% to 16.4%) of US visits categorized as most urgent versus 11.8% (95% Cl 11.8% to 11.8%) in Ontario. The proportion of all ED visits in which CT was performed was 11.4% (95% Cl 10.8% to 12.0%) in the United States versus 5.9% (95% Cl 5.9% to 5.9%) in Ontario. The proportion for children was 4.7% (95% Cl 4.3% to 5.1%) in the United States versus 1.4% (95% Cl 1.4% to 1.4%) in Ontario. The rate of visits involving CT per year increased faster from 2003 to 2008 in the United States (odds ratio 2.00; 95% Cl 1.81 to 2.21) than Ontario (odds ratio 1.69; 95% Cl 1.68 to 1.70). Over time, all subgroups experienced increases in CT rate except Ontario children younger than 10 years, who experienced a significant decrease. United States Ontario differences in CT proportions were significant among patients presenting with headache, abdominal pain, chest pain/shortness of breath, and complex abdominal pain. Proportions for visits involving admitted complex abdominal pain in the two jurisdictions were indistinguishable: 45.8% in the United States (95% Cl 39.9% to 51.7%) versus 44.7% (95% Cl 44.4% to 45.0%) in Ontario.Conclusion: CT was more readily available in US EDs, and US clinicians used the technology more frequently than their colleagues in Ontario for nearly every category of patients, including children. CT utilization increased over time in both jurisdictions, but faster in the United States. Different demographic features between the two jurisdictions, including triage severity, frequency of hospitalization, and availability of CT scanners, likely account for at least some of the differences in CT utilization. Investigation of both clinical and nonclinical reasons for the differences in CT utilization between the United States and Canada would be a fruitful area for further research.