Diagnostic Imaging in Emergency Medicine: How Much Is Too Much?

Baloescu, Cristiana

doi:10.1016/j.annemergmed.2018.06.034

Cited by 15 publications

(17 citation statements)

References 65 publications

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“…4,7 For instance, computed tomography (CT) scans use high doses of radiation and repeated exposure increases the risk of cancer, especially in children. 8,9 In addition to the radiation risks, some CT scans require injection of contrast that may lead to severe allergic reactions or post-contrast acute kidney injury. 8 In order to increase the appropriateness of imaging test requests by clinicians and to prioritize the tests, the American College of Radiology (ACR) formulated appropriateness criteria.…”

Section: Introductionmentioning

confidence: 99%

“…8,9 In addition to the radiation risks, some CT scans require injection of contrast that may lead to severe allergic reactions or post-contrast acute kidney injury. 8 In order to increase the appropriateness of imaging test requests by clinicians and to prioritize the tests, the American College of Radiology (ACR) formulated appropriateness criteria. 10 These criteria are evidence-based guidelines created to assist referring clinicians and other healthcare providers in making the best imaging or treatment decisions in specific clinical contexts.…”

Section: Introductionmentioning

confidence: 99%

“…10,11 Although ACR guidelines are being used worldwide, a large number of unnecessary imaging tests are still requested by EDs. 4,8 Considering the Portuguese reality, the National Health Directorate has been developing clinical practice guidelines since 2011 (Normas de Orientação Clínica) that provide crucial support tools to improve the quality of clinical practice, including imaging test appropriateness in some particular clinical contexts. 12 In addition, the clinical information provided by the attending clinician at the time of the test request is critical to assess not only the appropriateness of the test but also to improve the interpretation of its result.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

et al. 2020

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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.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…Fourth, one can also wonder to what extent the will to not take into account the results of the thoracic CT scan could subsequently translate into the will not to have asked for a thoracic CT scan for such a patient. It has indeed been reported that less-experienced physicians are more likely to use imaging, partly because they have less confidence in their diagnosis 22. Finally, agreement between emergency physicians and radiologists CT scan interpretation or between emergency physicians and the adjudication committee were moderate at best.…”

Section: Discussionmentioning

confidence: 96%

Impact of emergency physician experience on decision-making in patients with suspected community-acquired pneumonia and undergoing systematic thoracic CT scan

et al. 2019

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ObjectivesTo determine whether the impact of a thoracic CT scan on community-acquired pneumonia (CAP) diagnosis and patient management varies according to emergency physician’s experience (≤10 vs >10 years).MethodsEarly thoracic CT Scan for Community-Acquired Pneumonia at the Emergency Department is an interventional study conducted from November 2011 to January 2013 in four French emergency departments, and included suspected patients with CAP. We analysed changes in emergency physician CAP diagnosis classification levels before and after CT scan; and their agreement with an adjudication committee. We performed univariate analysis to determine the factors associated with modifying the diagnosis classification level to be consistent with the radiologist’s CT scan interpretation.Results319 suspected patients with CAP and 136 emergency physicians (75% less experienced with ≤10 years, 25% with >10 years of experience) were included. The percentage of patients whose classification was modified to become consistent with CT scan radiologist’s interpretation was higher among less-experienced than experienced emergency physicians (54.2% vs 40.2%; p=0.02). In univariate analysis, less emergency physician experience was the only factor associated with changing a classification to be consistent with the CT scan radiologist’s interpretation (OR 1.77, 95% CI 1.01 to 3.10, p=0.04). After CT scan, the agreement between emergency physicians and adjudication committee was moderate for less-experienced emergency physicians and slight for experienced emergency physicians (k=0.457 and k=0.196, respectively). After CT scan, less-experienced emergency physicians modified patient management significantly more than experienced emergency physicians (36.1% vs 21.7%, p=0.01).ConclusionsIn clinical practice, less-experienced emergency physicians were more likely to accurately modify their CAP diagnosis and patient management based on thoracic CT scan than more experienced emergency physicians.Trial registration numberNCT01574066

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“…Only 5% of head CT scans in patients with mild TBI are positive 5 however, the signi cance of missing an injury on CT scan has so far justi ed this ongoing liberal use. 6,7,8 The concern with the low rate of positive ndings on CT scans are that the scans are not risk free due to the radiation exposure. 9,10 In addition, they confer a signi cant cost to the health care system not only from the radiology costs, but those related to ED waiting times and LO.S 11 This variability and escalating CT use has led to the development of clinical guidelines and pathways to aid decision making.…”

Section: Introductionmentioning

confidence: 99%

Acute traumatic brain injury presentations and the use of head CT scans in the Emergency Department

Rogan¹,

Patel²,

Birdling³

et al. 2020

Preprint

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Objective: The use of CT head scanning for traumatic brain injury (TBI) is a vital diagnostic tool, guided by risk stratification tools. This study aims to review the use of CT head scans for TBI in two Australasian Emergency Departments (ED) in New Zealand.Methods: Retrospective observational design of patients referred for head CT from ED to exclude a significant intracranial injury between 1st September 2018 and 31st August 2019. Clinical data were collected regarding presenting patterns, identification of injuries on CT scan and adherence to CT guidelines.Results: Out of 425 cases reviewed, a clinically significant injury was identified in 41 (10%) patients. Patients who reported loss (32% vs 20% p < 0.05) or possible loss of consciousness (34% vs 22% p < 0.05) and had GCS < 13 (17% vs 8%, p < 0.05) or focal neurology (10% vs 3%, p < 0.05) were more likely to have a significantly intracranial injury on CT. Interestingly, 17 (41%) patients with significant injury were GCS 15 with no focal neurology. NICE guidelines were adhered to in 364 (86%) patients. In the 14% of cases that did not meet guideline criteria, all CT head scans were negative.Conclusion: CT head scans are a valuable tool in TBI and guidelines successfully identify those with significant intracranial injuries. However, the rate of significant injury for the total population requiring head CT remains low, with over 90% of head CTs in the population normal, despite high guideline compliance perhaps identifying a role for novel objective tests in ED guidelines internationally.

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Diagnostic Imaging in Emergency Medicine: How Much Is Too Much?

Cited by 15 publications

References 65 publications

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

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

Impact of emergency physician experience on decision-making in patients with suspected community-acquired pneumonia and undergoing systematic thoracic CT scan

Acute traumatic brain injury presentations and the use of head CT scans in the Emergency Department

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