Appropriateness of Radiology Test Requests by an Emergency Department: A Retrospective Study

Abstract

Introduction: Imaging tests are essential for diagnosis in the emergency context and convey clinical information that is essential to assess the appropriateness of the tests and improve their interpretation. Therefore, we aimed to analyze the imaging tests requested by the Emergency Department in a district hospital.Material and Methods: We retrospectively analyzed computed tomography and ultrasound scans requested by the Emergency Department at the Centro Hospitalar Universitário do Algarve and considered the following variables: requested test, clinical information provided (complete/incomplete), appropriateness of the test (appropriate/inappropriate), outcome (presence/absence of relevant findings) and findings related to the clinical information (yes/no). Pearson’s chi-squared and odds ratio association tests were used to evaluate the statistical association between the variables.Results: Out of 1427 requests, only 219 (15.3%) were considered to have complete clinical information. Nonetheless, 1075 (75.3%) requests were considered appropriate. Relevant findings were present in about one-third (n = 453; 31.7%) and most of these findings were related to the clinical context (n = 410; 90.5%). There was a significant association between test appropriateness and the presence of relevant findings in the test (p < 0.001). The odds ratio of having a relevant finding was 5.0 times higher in the tests considered appropriate when compared with those classified as inappropriate (CI = 3.4 - 7.3; p < 0.001).Discussion: The fact that appropriate tests potentiate the probability of having a relevant finding emphasizes the importance of defining guidelines so that only the adequate tests are performed.Conclusion: Creating guidelines should improve the appropriateness of imaging tests requested in the Emergency Department, yielding their result, with the consequent rationalization of the available resources.

Appropriateness of radiological diagnostic tests in otolaryngology

“…A systematic review focusing on cardiovascular pathology showed that between 7 and 23% of transthoracic echocardiograms performed were considered inappropriate; between 28 and 30% of stress echocardiograms were classified as inappropriate, together with 9% to 44% of cardiac CT studies and 4% to 46% of SPECT studies [20]. Moreover, a study which evaluated the appropriateness of imaging test requests in an emergency department showed that only 15.3% of the requests contained sufficient clinical information, a slightly higher percentage than that found in our own study [21].…”

Appropriateness of Computed Tomography and Ultrasound for Abdominal Complaints in the Emergency Department

“…Martins et al reported a 23.8% rate of inappropriate CTs and US (for all causes) in the ED, using the ACR guidelines as standard-of-care. 7 In that study, only 33.9% of all tests performed showed relevant findings. Similarly, overuse of head CT for minor head injury is also well reported in the literature, with inappropriate rates ranging from 30%-70% of cases.…”

“…Sample size was calculated for an estimated proportion of inappropriate tests of 25% based on the results of previous studies. 7,8 Using a margin of error of 0.075, a 95% confidence interval (95% CI), and a 20% expected rate of subjects with incomplete clinical information for the appropriateness of a test to be determined, the final sample size required was 154 patients for each imaging modality. Continuous variables are expressed as mean § SD and comparisons were performed using two-sample, two-tailed Student's t-test.…”

“…6 Despite the open availability of these guidelines and considered work in introducing them to nonradiology providers, approximately 25% of all US and CT scans ordered in the ED are considered inappropriate orders. 7 In light of the prevalence of abdominal complaints in the ED, the purpose of this study was to evaluate the appropriateness of US and CT scans ordered in the ED for this common complaint.…”

Audit of the appropriateness of the indication for obstetric sonography in a tertiary facility in Ghana

“…Several studies have shown flaws of practitioners in filling of radiological request forms [ 18 , 19 ]. An analysis of request forms from a previous study showed that a significant proportion of requests forms had no clinical information [ 20 ]. It was established that clinicians who request an imaging examination frequently experience several difficulties in getting the clinical history of the patient, mainly due to little/no information described in clinical records of patients and delay in laboratory results [ 20 ].…”