Broder Joshua, Warshauer David M
Division of Emergency Medicine, Box 3096, Duke University Medical Center, Durham, NC 27710, USA.
Emerg Radiol. 2006 Oct;13(1):25-30. doi: 10.1007/s10140-006-0493-9. Epub 2006 Aug 10.
This study aims to characterize changes in computed tomography (CT) utilization in the adult emergency department (ED) over a 5-year period. CT scans ordered on adult ED patients from July 2000 to July 2005 were analyzed in five groups: head, cervical spine, chest, abdomen, and miscellaneous. ED patient volume and triage acuity scores were determined. Triage acuity scores are used to determine the severity of a patient's illness or injury and the need for immediate evaluation and treatment. There were 46,553 CT scans performed on 27,625 adult patients in the ED during the study period. During this same period, 194,622 adult patients were evaluated in the ED. From 2000 to 2005, the adult emergency department patient volume increased by 13% while triage acuity remained stable. During this same period, head CT increased by 51%, cervical spine CT by 463%, chest CT by 226%, abdominal CT by 72%, and miscellaneous CT by 132%. Although increases were generally greater for patients over age 40, the increase in those less than 40 years was also substantial. Of the 4,320 individual patients who underwent chest CT, 83 (2%) had chest CT on three or more separate ED visits. Of 10,960 patients undergoing abdominal CT, 406 (4%) had abdominal CT on three or more separate ED visits. ED CT utilization has increased at a rate far exceeding the growth in ED patient volume. This presumably reflects the improved utility of CT in diagnosing serious pathology, its increased availability, and a desire on the part of physicians for diagnostic certainty. Whether this increase in utilization results in improved patient outcomes is at present unclear and deserves additional study.
本研究旨在描述成人急诊科（ED）在5年期间计算机断层扫描（CT）使用情况的变化。对2000年7月至2005年7月期间成年ED患者所开具的CT扫描进行了分析，分为五组：头部、颈椎、胸部、腹部和其他。确定了ED患者数量和分诊 acuity 评分。分诊 acuity 评分用于确定患者疾病或损伤的严重程度以及立即评估和治疗的必要性。在研究期间，ED对27,625名成年患者进行了46,553次CT扫描。在此期间，ED对194,622名成年患者进行了评估。从2000年到2005年，成人急诊科患者数量增加了13%，而分诊 acuity 保持稳定。在此期间，头部CT增加了51%，颈椎CT增加了463%，胸部CT增加了226%，腹部CT增加了72%，其他CT增加了132%。尽管40岁以上患者的增加幅度通常更大，但40岁以下患者的增加幅度也相当大。在接受胸部CT检查的4320名个体患者中，83名（2%）在三次或更多次不同的ED就诊中接受了胸部CT检查。在接受腹部CT检查的10960名患者中，406名（4%）在三次或更多次不同的ED就诊中接受了腹部CT检查。ED的CT使用量增长速度远远超过了ED患者数量的增长。这大概反映了CT在诊断严重病理方面的效用提高、其可及性增加以及医生对诊断确定性的渴望。目前尚不清楚这种使用量的增加是否会改善患者的预后，值得进一步研究。
