BackgroundExcessive use of computed tomography (CT) in emergency departments (EDs) has become a concern due to its expense and the potential risks associated with radiation exposure. Although studies have shown a steady increase in the number of CT scans requested by ED physicians in developed countries like the United States and Australia, few empirical data are available regarding China.Methods and FindingsWe retrospectively analyzed a database of ED visits to a tertiary Chinese hospital to examine trends in CT utilization and their association with ED outcomes between 2005 and 2008. A total of 197,512 ED visits were included in this study. CT utilization increased from 9.8% in 2005 to 13.9% in 2008 (P<.001 for trend). The ED length of stay for visits with CT utilization was 0.6 hour longer than those in which CT was not obtained. CT utilization increased the ED cost by an average $48.2. After adjustment for patients’ demographics, arrival hours and clinical condition, CT utilization during ED visits was significantly associated with high ED cost (Odds Ratio [OR]: 21.70; 95% confidence interval [CI], 17.00–27.71), long ED length of stay (OR: 1.22; 95%CI, 1.12–1.34), and more likely to receive emergency operations (OR: 2.31; 95%CI, 1.94–2.76). However, there was no significant correlation between CT use and the possibility to be admitted to inpatient wards (OR: 0.82; 95%CI, 0.65–1.04). With respect to the time-related trends, CT utilization during ED visits in all study years was significantly associated with high ED cost and more likely to receive emergency operations.ConclusionCT utilization was associated with higher ED cost, longer ED length of stay and more likely to receive emergency operations, but did not correlate with a significant change in the admission rate.

Backgroud: Studies of risk factors for prognosis of COVID-19 have increased rapidly, but researches about the association between albumin (ALB) levels and COVID-19 clinical outcomes are limited. This study aimed to investigate the relationship between admission albumin levels and adverse outcomes in patients with COVID-19.Methods: This study retrospectively-analyzed 199 COVID-19 patients come from five designated hospitals in Fujian Province between January 22 and February 27, 2020. Clinical characteristics and admission laboratory values were collected. Adverse outcomes were defined as meeting at least one of the following criteria: development of ARDS, respiratory failure, shock, MOF, ICU admissions and in-hospital mortality events.Results: After adjusting for potential confounders (age, sex, BMI, current smoking, hypertension, cardiovascular disease, pulmonary disease, tumor, chronic liver disease, D-dimer, creatinine, CK, leukocytes, neutrophil, LDH, BUN and fibrinogen), a non-linear relationship was detected between ALB and adverse comes, which had an inflection point of 32.6. The odds ratio and the confidence intervals on the left and right sides of the inflection point were 0.204 (0.061 to 0.681) and 0.908 (0.686 to 1.203), respectively. Conclusion: The relationship between ALB and adverse outcomes is non-linear. ALB was negatively correlated with adverse outcomes when ALB was less than 32.6.