Does diagnosis change as a result of repeat renal colic computed tomography scan in patients with a history of kidney stones?

Goldstone, A.R.; Bushnell, Andrew

doi:10.1016/j.ajem.2008.11.024

Cited by 37 publications

(24 citation statements)

References 13 publications

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“…56 We believe that the existing desire in modern U.S. health care, to minimize and even eliminate any diagnostic uncertainty, is a primary contributor to our current, resource-intensive approach. 5,32,57,58 While this professional culture may be well-intentioned, in the case of advanced imaging it has not only failed to improve patient outcomes, [11][12][13][14][15] but has also led to overdiagnosis Data are reported as number (%). EM = emergency medicine.…”

Section: Discussionmentioning

confidence: 99%

“…6 Within EM there is significant variation in test-ordering rates, [7][8][9][10] and there has been a tremendous increase in utilization of advanced imaging despite little evidence to suggest associated improvement in patient outcomes. [11][12][13][14][15] The etiology of this increase is likely multifactorial and may include malpractice fear, 16,17 desire for diagnostic certainty, 18 lack of or inconsistent clinical decision instruments, [18][19][20] poor adoption of such decision instruments, 21,22 inadequate training in evidenced-based medicine, 23,24 slow knowledge translation, 25 perverse financial incentives, 26 requests of consulting and referring physicians, 27,28 and increased practice intensity and overall complexity of emergency care. 28,29 Regardless of etiology, there has been a strong push within EM to counter this behavior to provide high-value, costconscious care.…”

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confidence: 99%

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Emergency Physician Perceptions of Medically Unnecessary Advanced Diagnostic Imaging

Kanzaria

Hoffman

Probst

et al. 2015

Academic Emergency Medicine

176

146

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Objectives: The objective was to determine emergency physician (EP) perceptions regarding 1) the extent to which they order medically unnecessary advanced diagnostic imaging, 2) factors that contribute to this behavior, and 3) proposed solutions for curbing this practice.Methods: As part of a larger study to engage physicians in the delivery of high-value health care, two multispecialty focus groups were conducted to explore the topic of decision-making around resource utilization, after which qualitative analysis was used to generate survey questions. The survey was extensively pilot-tested and refined for emergency medicine (EM) to focus on advanced diagnostic imaging (i.e., computed tomography [CT] or magnetic resonance imaging [MRI]). The survey was then administered to a national, purposive sample of EPs and EM trainees. Simple descriptive statistics to summarize physician responses are presented.Results: In this study, 478 EPs were approached, of whom 435 (91%) completed the survey; 68% of respondents were board-certified, and roughly half worked in academic emergency departments (EDs). Over 85% of respondents believe too many diagnostic tests are ordered in their own EDs, and 97% said at least some (mean = 22%) of the advanced imaging studies they personally order are medically unnecessary. The main perceived contributors were fear of missing a low-probability diagnosis and fear of litigation. Solutions most commonly felt to be "extremely" or "very" helpful for reducing unnecessary imaging included malpractice reform (79%), increased patient involvement through education (70%) and shared decision-making (56%), feedback to physicians on test-ordering metrics (55%), and improved education of physicians on diagnostic testing (50%). Conclusions:Overordering of advanced imaging may be a systemic problem, as many EPs believe a substantial proportion of such studies, including some they personally order, are medically unnecessary. Respondents cited multiple complex factors with several potential high-yield solutions that must be addressed simultaneously to curb overimaging.ACADEMIC EMERGENCY MEDICINE 2015;22:390-398

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Emergency Physician Perceptions of Medically Unnecessary Advanced Diagnostic Imaging

Kanzaria

Hoffman

Probst

et al. 2015

Academic Emergency Medicine

176

146

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show abstract

“…CT scans exposed patients to two hundred to one thousand and five hundred times the radiation of just one chest x-ray (Westphalen, Hsia, Maselli, Wang, & Gonzales, 2011). The risk from fatal cancer was estimated at 0.05 percent per each abdominal CT scan which is significantly high (Goldstone & Bushnell, 2010).…”

Section: Background/statement Of the Problemmentioning

confidence: 90%

“…The scores were validated on all 2,315 patients included in the study. Goldstone and Bushnell (2010) performed a retrospective chart review on ED patients to determine if CT scans changed diagnosis on patients with a history of renal calculi. Inclusion criteria were all ED patients who received a CT for renal colic after previously receiving the diagnosis of an obstructive renal calculus by CT during a previous ED admission and were eighteen years old or older.…”

Section: Current Research Inmentioning

confidence: 99%

Computed Tomographic Scans on Patients with Repeat Renal Calculi: A Pilot Study

Reposa

2016

Preprint

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Patients at risk for repeat renal calculi presenting to the ED with symptoms similar to their previous episodes, are likely to be over-exposed to computed tomographic (CT) scans. With recurrence at fifty percent minimizing CT use in this population is imperative (Goertz & Lotterman, 2010). Studies indicate using urinalysis and alternative imaging methods are necessary to prevent increases in radiation exposure, cost and ED visit time.The purpose of the project was to decrease CT use by providing current evidence-based research to ED providers on the overuse of CT scans for patients with a history of renal calculi who present with symptoms comparable to previous episodes. Using the logical model, the project was a retrospective chart review. The study took place in Charlton Memorial Hospital's ED. Charts were reviewed of patients who had a history of renal calculi and presented to the ED with flank pain. Patients were excluded for age less than eighteen, recent surgery, and chronic renal failure and/or dialysis due to renal impairment at baseline. The pre-presentation chart review was to assess the need to decrease CT scan ordering in the given population. An informational session on current research was provided to the providers and a post presentation chart review was completed to evaluate if there was a subsequent decrease in CT ordering. The study proved using evidencebased research to educate providers could result in a decreased amount of CT scans ordered. CT scans were ordered, eighty percent pre-presentation and decreased to sixtyfive percent post.

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“…While there is a large and growing body of literature regarding computerized imaging decision support and how it may be used to affect utilization, variation, and appropriateness, [9][10][11][12] there is unfortunately a paucity of research examining the effects of individual physician feedback on test-ordering metrics. While diagnostic imaging use has increased in the absence of demonstrable benefits, 13,14 an understanding of the reasons for this increase and how to change clinicians' behavior is needed.…”

mentioning

confidence: 99%

Medically Unnecessary Advanced Diagnostic Imaging and Shared Decision‐making in the Emergency Department: Opportunities for Future Research

Hess

Marin

Mills

2015

Academic Emergency Medicine

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Does diagnosis change as a result of repeat renal colic computed tomography scan in patients with a history of kidney stones?

Cited by 37 publications

References 13 publications

Emergency Physician Perceptions of Medically Unnecessary Advanced Diagnostic Imaging

Emergency Physician Perceptions of Medically Unnecessary Advanced Diagnostic Imaging

Computed Tomographic Scans on Patients with Repeat Renal Calculi: A Pilot Study

Medically Unnecessary Advanced Diagnostic Imaging and Shared Decision‐making in the Emergency Department: Opportunities for Future Research

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