National Trends in Use of Computed Tomography in the Emergency Department
National Trends in Use of Computed Tomography in the Emergency Department
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DOI：
10.1016/j.annemergmed.2011.05.020
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发表时间：
2011-11-01
影响因子：
6.2
通讯作者：
Nallamothu, Brahmajee K.
中科院分区：
文献类型：
--
作者：
Kocher, Keith E.;Meurer, William J.;Nallamothu, Brahmajee K.
研究目的：近年来，计算机断层扫描（CT）在急性疾病中的作用大幅增加，然而，很少有人知道如何在急诊科（艾德）CT的使用已经改变了随着时间的推移。方法：一项回顾性研究进行了1996年至2007年全国医院门诊医疗服务调查，一个大型的全国性调查艾德服务。我们评估了在此期间艾德访视期间CT使用的变化，CT用于特定艾德表现的投诉，以及CT使用后的处置。主要结果显示为调整后的风险比（RRs）。结果：在12年期间，来自368，680例患者就诊的数据产生了估计12.9亿次加权艾德遭遇的结果，其中估计有9710万（7.5%）患者接受了至少一次CT。总体而言，艾德访视期间CT使用增加了330%，从1996年的3.2%（95%置信区间[CI] 2.9%至3.6%）增加到2007年的13.9%（95% CI 12.8%至14.9%）。在艾德最常见的20种投诉中，CT的使用普遍增加。腹痛的增长率最高（2007年与1996年相比的调整后RR =9.97; 95% CI 7.47 - 12.02），胁腹疼痛（校正RR 9.24; 95% CI 6.22 - 11.51），胸痛（调整后RR 5.54; 95% CI 3.75 - 7.53）和呼吸短促（调整后RR 5.28; 95% CI 2.76 - 8.34）。在多变量建模中，CT扫描后入院或转院的可能性多年来有所下降，但最近趋于平稳（2007年至1996年CT扫描后入院或转院的调整后RR =0.42; 95% CI 0.32至0.55）。结论：CT在艾德的使用近年来在广泛的主诉中显著增加。这一增加与CT使用后的入院或转院人数下降有关，尽管这种影响最近已经稳定下来。[Ann 2011;58：452-462.]
Study objective: The role of computed tomography (CT) in acute illnesses has increased substantially in recent years; however, little is known about how CT use in the emergency department (ED) has changed over time.Methods: A retrospective study was performed with the 1996 to 2007 National Hospital Ambulatory Medical Care Survey, a large nationwide survey of ED services. We assessed changes during this period in CT use during an ED visit, CT use for specific ED presenting complaints, and disposition after CT use. Main outcomes were presented as adjusted risk ratios (RRs).Results: Data from 368,680 patient visits during the 12-year period yielded results for an estimated 1.29 billion weighted ED encounters, among which an estimated 97.1 million (7.5%) patients received at least one CT. Overall, CT use during ED visits increased 330%, from 3.2% of encounters (95% confidence interval [CI] 2.9% to 3.6%) in 1996 to 13.9% (95% CI 12.8% to 14.9%) in 2007. Among the 20 most common complaints presenting to the ED, there was universal increase in CT use. Rates of growth were highest for abdominal pain (adjusted RR comparing 2007 to 1996=9.97; 95% CI 7.47 to 12.02), flank pain (adjusted RR 9.24; 95% CI 6.22 to 11.51), chest pain (adjusted RR 5.54; 95% CI 3.75 to 7.53), and shortness of breath (adjusted RR 5.28; 95% CI 2.76 to 8.34). In multivariable modeling, the likelihood of admission or transfer after a CT scan decreased over the years but has leveled off more recently (adjusted RR comparing admission or transfer after CT in 2007 to 1996=0.42; 95% CI 0.32 to 0.55).Conclusion: CT use in the ED has increased significantly in recent years across a broad range of presenting complaints. The increase has been associated with a decline in admissions or transfers after CT use, although this effect has stabilized more recently. [Ann Emerg Med. 2011;58:452-462.]