Are all after-hours diagnostic imaging appropriate? An Australian Emergency Department pilot study

Gardiner, Fergus William; Zhai, Shaun

doi:10.1016/j.amsu.2016.11.019

Cited by 4 publications

(15 citation statements)

References 17 publications

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“…Other studies reported similar reasons for inappropriate radiologic workup: medico-legal issues, [5] diagnostic uncertainty, [6] inadequate education and training, [7] requests from consulting subspecialty physicians, increased workloads within the ED, [8] and patient self-referral. [9] Contrary to our data, Gardiner and Zhai [10] reported just 0.8% of CXRs performed during off hours as inappropriate in a study from a teaching hospital in Australia.…”

Section: Discussioncontrasting

confidence: 99%

Does shifting to professional emergency department staffing affect the decision for chest radiography?

Pavlov¹,

Klobučar²,

Klobučar³

et al. 2021

World Journal of Emergency Medicine

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BACKGROUND: The study aims to determine whether shifting to professional emergency department (ED) teams leads to a higher rate of radiologic workup. METHODS: We retrospectively analyzed a total of 2,000 patients presenting to the ED of a tertiary teaching hospital in two time periods: group 1 (G1) comprised 1,000 consecutive patients enrolled from December 21, 2012 to January 5, 2013 (all patients were examined by an internal medicine specialist); group 2 (G2) comprised 1,000 consecutive patients enrolled from December 21, 2018 to January 3, 2019 (all patients were examined by an emergency physician). RESULTS: The chest X-ray (CXR) was performed in 40.6% of all patients. There was no difference in the frequency of CXR (38.9% in G1 vs. 42.3% in G2, P=0.152). More CXRs were performed in G2 patients older than 65 years, in female patients older than 65 years, in patients presenting during the evening and night shifts or off-hours, in patients with a history of malignancy, in patients with gastrointestinal bleeding, and in patients with bradycardia, but fewer in patients presenting with arrhythmia. No diff erence in the rates of pathological CXR was found (47.3% in G1 vs. 52.2% in G2, P=0.186). Compared with G2, higher sensitivity and specifi city were obtained for the binary logistic regression model predicting pathological fi ndings in G1. CONCLUSIONS: Shifting to professional ED teams does not increase radiologic workup. By implementing deliberate usage of ultrasound, some self-governing procedures, case-oriented investigations, and center-specifi c recommendations, unnecessary radiologic workup can be avoided. Professional ED teams could lead to a higher standard of emergency care.

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Section: Discussioncontrasting

confidence: 99%

Does shifting to professional emergency department staffing affect the decision for chest radiography?

Pavlov¹,

Klobučar²,

Klobučar³

et al. 2021

World Journal of Emergency Medicine

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“…Nonetheless, a lower appropriateness rate compared with other hospital settings, such as the emergency department, was shown. 14 …”

Section: Discussionmentioning

confidence: 99%

To what extent do hospitalised patients receive appropriate CT and MRI scans? Results of a cross-sectional study in Southern Italy

et al. 2018

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ObjectivesThe aim of this study was to assess the frequency of appropriateness of inpatient CT and MRI scans performed in Southern Italy.MethodsThe study was carried out by retrospectively reviewing medical records of adult patients admitted between 1 January and 31 December 2012 in two hospitals. The evaluation of appropriateness was performed according to the American College of Radiology Appropriateness Criteria, which assigns a score between 1 and 9.ResultsEight hundred and fifty-three medical records were reviewed. Six hundred and thirty-nine patients received CT examinations and 256 received MRI examinations. Four hundred and ninety-six (77.6%) of the patient population had appropriate CT and 202 (78.9%) received appropriate MRI examinations. The appropriateness was associated with: a confirmation of the diagnostic hypothesis, only one examination performed during hospital stay, the anatomical scan region, with musculoskeletal system being the least appropriate anatomical scan region. Moreover, for CT examinations, appropriateness was also associated with no use of contrast agent.ConclusionsOur findings highlight the need to reduce inappropriate use of CT and MRI. The study showed that the tool used is reliable to measure the extent of appropriateness of diagnostic imaging for inpatient examinations.

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“…26 studies rated 26,715 CTs [21, 23, 63-65, 67, 72-74, 76, 77, 81, 83, 86, 89, 92, 93, 98-104, 106, 107] with an overall appropriateness of 60% (n = 16,363/27,309). Eleven studies [20, 23, 62, 66, 83-85, 87-89, 104] reported an appropriateness of 55% in 7729 reviewed radiographs (n = 4271/7729) and two studies [88,104] reviewed 1535 radiological ultrasounds with an overall appropriateness of 44% (n = 680/1535). Overall, there are no patterns regarding size of study population and appropriateness (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Nine studies reviewed [74,81,100]. The appropriateness of head/neck CT in adults/ patients of unknown age was rated with national guidelines [21,63,72,104], EU guidelines [100] or ACR AC [93,101]. It varied between 44% (n = 26/59) [63] and 98% (n = 63/64) [104], averaging out at an overall appropriateness of 79% (n = 532/675).…”

Section: Resultsmentioning

confidence: 99%

Measuring appropriateness of diagnostic imaging: a scoping review

et al. 2023

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In radiology, the justification of diagnostic imaging is a key performance indicator. To date, specific recommendations on the measurement of appropriateness in diagnostic imaging are missing. To map the study literature concerning the definition, measures, methods and data used for analyses of appropriateness in research of diagnostic imaging. We conducted a scoping review in Medline, EMBASE, Scopus and the Cochrane Central Register of Controlled Trials. Two independent reviewers undertook screening and data extraction. After screening 6021 records, we included 50 studies. National guidelines (n = 22/50) or American College of Radiology Appropriateness Criteria (n = 23/50) were used to define and rate appropriateness. 22/50 studies did not provide methodological details about the appropriateness assessment. The included studies varied concerning modality, amount of reviewed examinations (88–13,941) and body regions. Computed tomography (27 studies, 27,168 examinations) was the most frequently analyzed modality, followed by magnetic resonance imaging (17 studies, 6559 examinations) and radiography (10 studies, 7095 examinations). Heterogeneous appropriateness rates throughout single studies (0–100%), modalities, and body regions (17–95%) were found. Research on pediatric and outpatient imaging was sparse. Multicentric, methodologically robust and indication-oriented studies would strengthen appropriateness research in diagnostic imaging and help to develop reliable key performance indicators.

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Are all after-hours diagnostic imaging appropriate? An Australian Emergency Department pilot study

Cited by 4 publications

References 17 publications

Does shifting to professional emergency department staffing affect the decision for chest radiography?

Does shifting to professional emergency department staffing affect the decision for chest radiography?

To what extent do hospitalised patients receive appropriate CT and MRI scans? Results of a cross-sectional study in Southern Italy

Measuring appropriateness of diagnostic imaging: a scoping review

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