Trends in Computed Tomography Utilization and Association with Hospital Outcomes in a Chinese Emergency Department

Zhou, Jian; Zheng, San Wei; Yu, Yun Xian; Rouleau, Keith; Wei, Junhu; Jin, Chong Wu; Zhou, Dao; Pan, Kong; Yu, Yun Song

doi:10.1371/journal.pone.0040403

Cited by 28 publications

(26 citation statements)

References 20 publications

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“…The result of our research correlates with previous studies suggesting a dramatic increase in ED CT utilisation over the 5 year span of the study . The rate of increase outpaced the increase in ED patient volume.…”

Section: Discussionsupporting

confidence: 88%

“…Under global budget policy, the overall CAGR in Taiwan was 7.2% from 2005 to 2009. This was much lower than the 15.1% CAGR in Korea from 2001 to 2010, the 14.3% CAGR in the USA from 1996 to 2007 and the 12.4% CAGR in China from 2005 to 2008 . To our surprise, the total CT utilisation of 153 per 1000 ED visits in Taiwan in 2009 was the second highest compared with the 330 in Korea (in 2010), 139 in the USA (in 2007) and 139 in China (in 2008).…”

Section: Discussionmentioning

confidence: 65%

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Trends in computed tomography utilisation in the emergency department: A 5 year experience in an urban medical centre in northern Taiwan

Chang

Lin

Hsu

et al. 2016

Emerg Medicine Australasia

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 65%

Trends in computed tomography utilisation in the emergency department: A 5 year experience in an urban medical centre in northern Taiwan

Chang

Lin

Hsu

et al. 2016

Emerg Medicine Australasia

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“…They need to rapidly and accurately diagnose and decide on a patient's disposition, while making use of the least invasive modality of diagnostic testing. [5,6] In the ED setting, providers may tend to overutilise CT scans. [2,7] Other factors contributing to CT over-utilisation may include fear of a missed or incorrect diagnosis, the potential for malpractice lawsuits, as well as inadequate knowledge and awareness of radiation exposure and potential risk of inducing cancer.…”

Section: Researchmentioning

confidence: 99%

High positive computed tomography yields in the emergency department might not be a positive finding

Swartzberg

Goldstein

2018

S Afr Med J

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Background. There is growing pressure to reduce unnecessary computed tomography (CT) imaging requests that the radiology department receives from the emergency department (ED); however, information on acceptable usage rates and diagnostic yields remains scanty. Objectives. To describe the indications, clinical categories and positive yield rates of patients receiving CT scans in the ED. Methods. A retrospective record review was done of all patients who received CT scans at an urban, adult academic ED during a 4-month period. Primary outcomes were to establish CT scan usage and positive yield rates. Other outcomes included analysis of indications, demographics and anatomical areas scanned. Results. Scans (n=1 010) were analysed. The median age of patients was 36 (range 4 -93) years. Male patients received 64.3% of all scans, as well as 75.7% of the scans performed for trauma. The majority of the scans were for trauma patients. However, non-trauma patients had a higher positive yield; the non-trauma positive yield rate was 61.8% compared with the trauma positive yield rate of 47.1% (p<0.001). The majority of scans performed were of the head (58%) and neck (20%), with lowest positive yield rates of 48.9% and 17%, respectively. The overall CT scan usage rate was 4.6% and overall positive rate 53.8%. Conclusion. A negative CT scan does not necessarily mean that the test was not indicated. Higher positive yield rates may reflect insufficient use of CT scanning by the ED. Local guidelines should be established to ensure judicious and effective clinical use of CT scans.

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“…However, uncoordinated imaging of the same patient across different care settings can result in increased radiation exposure and health care expenditures, some of which may be avoidable [1]. The utilization of CT scanning has increased impressively over the past few decades in the United States and around the world [2][3][4][5][6]. The increased use of CT scans is particularly notable in urgent or emergent care settings, where time to diagnose problems is short and radiology management preauthorization programs do not apply [6][7][8][9][10].…”

mentioning

confidence: 99%

“…The utilization of CT scanning has increased impressively over the past few decades in the United States and around the world [2][3][4][5][6]. The increased use of CT scans is particularly notable in urgent or emergent care settings, where time to diagnose problems is short and radiology management preauthorization programs do not apply [6][7][8][9][10]. In a study of more than 3 million emergency department (ED) claims filed in 41 states in 2006, 16.7% of all adults who had been seen in an ED had undergone a CT scan during the visit [7].…”

mentioning

confidence: 99%

With “Big Data” Comes Big Responsibility

Biola

Best

Lahlou

et al. 2014

North Carolina Medical Journal

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background Patients are being exposed to increasing levels of ionizing radiation, much of it from computed tomography (CT) scans. methods Adults without a cancer diagnosis who received 10 or more CT scans in 2010 were identified from North Carolina Medicaid claims data and were sent a letter in July 2011 informing them of their radiation exposure; those who had undergone 20 or more CT scans in 2010 were also telephoned. The CT scan exposure of these high-exposure patients during the 12 months following these interventions was compared with that of adult Medicaid patients without cancer who had at least 1 CT scan but were not in the intervention population. results The average number of CT scans per month for the high-exposure population decreased over time, but most of that reduction occurred 6-9 months before our interventions took place. At about the same time, the number of CT scans per month also decreased in adult Medicaid patients without cancer who had at least 1 CT scan but were not in the intervention population. limitations Our data do not include information about CT scans that may have been performed during times when patients were not covered by Medicaid. Some of our letters may not have been received or understood. Some high-exposure patients were unintentionally excluded from our study because organization of data on Medicaid claims varies by setting of care. conclusion Our patient education intervention was not temporally associated with significant decreases in subsequent CT exposure. Effecting behavior change to reduce exposure to ionizing radiation requires more than an educational letter or telephone call. 103NCMJ vol. 75, no. 2 ncmedicaljournal.com their risks [22,23]. Recently a large hospital system also launched a program that allows patients and physicians to get information from the patient's electronic health record about his or her radiation exposure within that hospital system [24]. However, the literature does not include any largescale efforts by insurers to reach high-exposure patients, nor are there any follow-up studies of the effect of such outreach efforts.Community Care of North Carolina (CCNC) is a nonprofit organization that partners with the North Carolina Division of Medical Assistance (DMA), which operates the state's Medicaid program. One of CCNC's goals is to promote wellness by reinforcing each Medicaid recipient's relationship with his or her primary care medical home [25]. Through 14 regional networks consisting of physicians, nurses, pharmacists, care managers, and other staff, CCNC has ongoing care improvement projects including state-level efforts, region-specific pilots, and projects focused on specific patient populations.In one state-level project, a team of physicians, nurses, analysts, and DMA staff members review outlier claims to see whether unusual billing patterns indicate a need for changes in policies or care pathways. A physician on this team had seen a patient who questioned the safety of the high number of CT scans he had received during the past ye...

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Trends in Computed Tomography Utilization and Association with Hospital Outcomes in a Chinese Emergency Department

Cited by 28 publications

References 20 publications

Trends in computed tomography utilisation in the emergency department: A 5 year experience in an urban medical centre in northern Taiwan

Trends in computed tomography utilisation in the emergency department: A 5 year experience in an urban medical centre in northern Taiwan

High positive computed tomography yields in the emergency department might not be a positive finding

With “Big Data” Comes Big Responsibility

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