A Systematic Review of Interventions to Reduce Computed Tomography Usage in the Emergency Department

Dunne, Cody; Elzinga, Jason L; Vorobeichik, Allen; Sudershan, Sanjana; Keto‐Lambert, Diana; Lang, Eddy; Dowling, Shawn

doi:10.1016/j.annemergmed.2022.06.001

Cited by 22 publications

(8 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A total of 91 publications were identified and included in this report. Among the Canadian publications, some were from pan-Canadian groups or were relevant to Canada in general 3,8,[10][11][12][13][14][15][16][17][18] ; others were action plans, initiatives, or studies from specific provinces, including British Columbia, [19][20][21] Alberta, 6,22 Saskatchewan, 23,24 Manitoba, 25,26 Ontario, [27][28][29][30][31][32][33][34][35][36][37][38] Quebec, 39 Prince Edward Island, 16 Newfoundland, 40 Nova Scotia, 41,42 New Brunswick, 43 and Yukon. 44 Publications were also identified from Australia, 45,46 China, 47,48 the European Union, 49 France, 50,51 India, 52 Ireland, 53 Israel,…”

Section: Resultsmentioning

confidence: 99%

“…• Referring patients to alternative exams or care pathways when appropriate 21,62,63,75,76 • Implementing monitoring and feedback mechanisms for referring clinicians 18,26 • Avoiding duplicates (imaging when patient's health has not changed, such as extending time intervals between repeat exams as appropriate) and exams when there is insufficient patient information 61…”

Section: Type Of Strategy Examplesmentioning

confidence: 99%

See 1 more Smart Citation

Wait List Strategies for CT and MRI Scans

CADTH¹

2023

cjht

View full text Add to dashboard Cite

There are various potential causes of long wait times for CT and MRI scans, and conducting a situation-specific assessment of available resources and potential cause(s) of wait times may help to identify appropriate strategies for their management. Identified principles for developing a plan to address wait times include engaging stakeholders, taking a coordinated approach to develop short- and long-term plans, ensuring plans are flexible to account for changes in technologies, and developing a plan for quality monitoring and assessment of specified outcomes. Identified strategies for reducing wait times for CT and/or MRI scans include increasing capacity, improving efficiencies, reducing low-value scans, improving communication, and adopting new technology.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Type Of Strategy Examplesmentioning

confidence: 99%

Wait List Strategies for CT and MRI Scans

CADTH¹

2023

cjht

View full text Add to dashboard Cite

show abstract

“…After record identification, data were exported into Endnote, and duplicates were deleted. After data were imported into Rayan from Endnote, 1st and 2nd screenings were conducted by four reviewers with reliable interrater reproducibility (κ value of 0.78 [95% CI: 0.68 to 0.87]), based on a previous study [ 16 ]. The 1st screening was conducted from the titles and abstracts of each set of retrieved data.…”

Section: Methodsmentioning

confidence: 99%

Instruments to assess post-intensive care syndrome assessment: a scoping review and modified Delphi method study

Nakanishi,

Liu,

Kawauchi

et al. 2023

Crit Care

View full text Add to dashboard Cite

Background The assessment of post-intensive care syndrome (PICS) is challenging due to the numerous types of instruments. We herein attempted to identify and propose recommendations for instruments to assess PICS in intensive care unit (ICU) survivors. Methods We conducted a scoping review to identify PICS follow-up studies at and after hospital discharge between 2014 and 2022. Assessment instruments used more than two times were included in the modified Delphi consensus process. A modified Delphi meeting was conducted three times by the PICS committee of the Japanese Society of Intensive Care Medicine, and each score was rated as not important (score: 1–3), important, but not critical (4–6), and critical (7–9). We included instruments with ≥ 70% of respondents rating critical and ≤ 15% of respondents rating not important. Results In total, 6972 records were identified in this scoping review, and 754 studies were included in the analysis. After data extraction, 107 PICS assessment instruments were identified. The modified Delphi meeting reached 20 PICS assessment instrument recommendations: (1) in the physical domain: the 6-min walk test, MRC score, and grip strength, (2) in cognition: MoCA, MMSE, and SMQ, (3) in mental health: HADS, IES-R, and PHQ-9, (4) in the activities of daily living: the Barthel Index, IADL, and FIM, (5) in quality of life: SF-36, SF-12, EQ-5D-5L, 3L, and VAS (6), in sleep and pain: PSQI and Brief Pain Inventory, respectively, and (7) in the PICS-family domain: SF-36, HADS, and IES-R. Conclusion Based on a scoping review and the modified Delphi method, 20 PICS assessment instruments are recommended to assess physical, cognitive, mental health, activities of daily living, quality of life, sleep, and pain in ICU survivors and their families.

show abstract

“…Overuse of CT leads to unnecessary costs and increased length of stay. Numerous strategies have been developed to curb the use of CT [ 12 , 13 ]. To reduce the number of unnecessary CT scans, a biomarker with a high sensitivity for AAD would be ideal to facilitate a diagnosis, as this is currently being adopted in some other parts of the world.…”

Section: Introductionmentioning

confidence: 99%

D-dimer as a Rule-Out for Aortic Dissection

Carter,

Tom,

Sunesra

et al. 2023

Cureus

View full text Add to dashboard Cite

Introduction Acute aortic dissection (AAD) represents a significant diagnostic challenge with a high mortality rate if not treated promptly. This challenge arises from the diverse clinical presentations of AAD, and its symptom overlap with other medical conditions. Although both helical CT and transesophageal echocardiography are reliable diagnostic tools for AAD, they are not feasible for every suspected case. Furthermore, limited research on D-dimer's utility in ruling out AAD has been conducted due to the condition’s rarity. Methods This study utilizes the TriNetX database ( https://trinetx.com /), encompassing data from 54 healthcare organizations across the United States over the past two decades from 85 million patients. The objective is to evaluate the sensitivity of an elevated D-dimer level in diagnosing AAD across a much larger patient cohort than previously studied. Results Retrospectively analyzing this dataset, there were 1,319 patients identified with a confirmed AAD who had undergone D-dimer testing within a day of diagnosis. Of these, 1,252 patients exhibited D-dimer levels exceeding 400 ng/ml while 1,227 had levels surpassing 500 ng/ml. Notably, a D-dimer cutoff of 400 ng/ml demonstrated a sensitivity of 0.949 while a 500 ng/ml cutoff yielded a sensitivity of 0.930. Conclusion This large retrospective cohort study demonstrates that a blood D-dimer level is highly sensitive in assaying for AAD. The D-dimer levels analyzed showed a remarkable sensitivity in ruling out AAD, avoiding the need for more invasive testing in low-risk patients.

show abstract

A Systematic Review of Interventions to Reduce Computed Tomography Usage in the Emergency Department

Cited by 22 publications

References 30 publications

Wait List Strategies for CT and MRI Scans

Wait List Strategies for CT and MRI Scans

Instruments to assess post-intensive care syndrome assessment: a scoping review and modified Delphi method study

D-dimer as a Rule-Out for Aortic Dissection

Contact Info

Product

Resources

About