Kirsch Thomas D, Hsieh Yu-Hsiang, Horana Lasantha, Holtzclaw Stephen G, Silverman Michael, Chanmugam Arjun
Department of Emergency Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA.
J Emerg Med. 2011 Sep;41(3):302-9. doi: 10.1016/j.jemermed.2010.06.030. Epub 2010 Oct 15.
Increased utilization of computed tomography (CT) in emergency departments (EDs) has become a concern due to its expense and the potential risks associated with radiation exposure.
To describe the predictors of CT utilization based on patient, provider, and ED characteristics.
There were 3,217,396 ED patient visits during a 12-month period that were included in this retrospective analysis of a database from a single billing company that included 227 EDs in 41 states. Data were collected between January 1, 2006 and December 31, 2006 and included patient visit information, CT use for each patient visit, patient demographics, ED provider information, and ED volume.
The CT utilization rate was 16.7% (95% confidence interval [CI] 16.7-16.8%) for adults, whereas in pediatric patients (< 18 years of age) it was 5.3% (95% CI 5.3-5.4%). The adult CT utilization rate ranged from 11.3% (95% CI 11.2-11.4%) at age 20-29 years to 24.6% (95% CI 24.5-24.8%) for those>65 years of age. For the admitted patients, the CT utilization rate was 27.8% (95% CI 27.6-27.9%); for the patients transferred out of the hospital, the CT utilization rate was 23.2% (95% CI 22.9-23.6%). Discharged patients had a rate of 11.3% (95% CI 11.2-11.3%) and patients who left against medical advice had a scan rate of 20.2% (95% CI 19.6-20.7%). The CT utilization rate was 9.3% (95% CI 9.2-9.4%) in EDs with<20,000 annual visits and increased to 17.8% (95% CI 17.7-17.9%) in EDs with volumes of>40,000. The CT utilization rate was 16.1% (95% CI 16.1-16.2%) for emergency medicine boarded physicians vs. 11.3% (95% CI 11.3-11.4%) for non-emergency-medicine boarded physicians.
CT utilization by EDs seems to vary by a number of parameters, including patient age, ED volume, training background of the provider, and disposition status of the patient.
由于计算机断层扫描（CT）的费用以及与辐射暴露相关的潜在风险，急诊科（ED）中CT使用的增加已成为一个令人担忧的问题。
根据患者、医护人员和急诊科的特征描述CT使用的预测因素。
在为期12个月的时间段内，对来自一家单一计费公司数据库的3217396例急诊科患者就诊情况进行了回顾性分析，该数据库包含41个州的227家急诊科。数据收集于2006年1月1日至2006年12月31日期间，包括患者就诊信息、每次患者就诊时的CT使用情况、患者人口统计学信息、急诊科医护人员信息以及急诊科就诊量。
成人的CT使用率为16.7%（95%置信区间[CI]16.7 - 16.8%），而儿科患者（<18岁）的CT使用率为5.3%（95%CI 5.3 - 5.4%）。成人CT使用率在20 - 29岁年龄段为11.3%（95%CI 11.2 - 11.4%），在65岁以上人群中为24.6%（95%CI 24.5 - 24.8%）。对于住院患者，CT使用率为27.8%（95%CI 27.6 - 27.9%）；对于转院患者，CT使用率为23.2%（95%CI 22.9 - 23.6%）。出院患者的使用率为11.3%（95%CI 11.2 - 11.3%），自动离院患者的扫描率为20.2%（95%CI 19.6 - 20.7%）。年就诊量<20000人次的急诊科CT使用率为9.3%（95%CI 9.2 - 9.4%），就诊量>40000人次的急诊科CT使用率增至17.8%（95%CI 17.7 - 17.9%）。急诊医学专科医生的CT使用率为16.1%（95%CI 16.1 - 16.2%），而非急诊医学专科医生的CT使用率为11.3%（95%CI 11.3 - 11.4%）。
急诊科的CT使用似乎因多个参数而异，包括患者年龄、急诊科就诊量、医护人员的培训背景以及患者的处置状态。
