Department of Radiology and Biomedical Imaging, University of California at San Francisco, USA.
Acad Emerg Med. 2011 Jul;18(7):699-707. doi: 10.1111/j.1553-2712.2011.01103.x.
Overutilization of computed tomography (CT) is a growing public health concern due to increasing health care costs and exposure to radiation; these must be weighed against the potential benefits of CT for improving diagnoses and treatment plans. The objective of this study was to determine the national trends of CT and ultrasound (US) utilization for assessment of suspected urolithiasis in emergency departments (EDs) and if these trends are accompanied by changes in diagnosis rates for urolithiasis or other significant disorders and hospitalization rates.
This was a retrospective cross-sectional analysis of ED visits from the National Hospital Ambulatory Medical Care Survey (NHAMCS) between 1996 and 2007. The authors determined the proportion of patient visits for flank or kidney pain receiving CT or US testing and calculated the diagnosis and hospitalization rates for urolithiasis and other significant disorders. Patient-specific and hospital-level variables associated with the use of CT were examined.
Utilization of CT to assess patients with suspected urolithiasis increased from 4.0% to 42.5% over the study period (p < 0.001). In contrast, the use of US remained low, at about 5%, until it decreased beginning in 2005 to 2007 to 2.4% (p = 0.01). The proportion of patients diagnosed with urolithiasis (approximately 18%, p = 0.55), with other significant diagnoses (p > 0.05), and admitted to the hospital (approximately 11%, p = 0.49) did not change significantly. The following characteristics were associated with a higher likelihood of receiving a CT scan: male sex (odd ratio [OR] = 1.83, 95% confidence interval [CI] = 1.22 to 2.77), patients presenting with severe pain (OR = 2.96, 95% CI = 1.14 to 7.65), and those triaged in 15 minutes or less (OR = 2.41, 95% CI = 1.08 to 5.37). CT utilization was lower for patients presenting to rural hospitals (vs. urban areas; OR = 0.34, 95% CI = 0.19 to 0.61) and those managed by a nonphysician health care provider (OR = 0.19, 95% CI = 0.07 to 0.53).
From 1996 to 2007, there was a 10-fold increase in the utilization of CT scan for patients with suspected kidney stone without an associated change in the proportion of diagnosis of kidney stone, diagnosis of significant alternate diagnoses, or admission to the hospital.
由于医疗保健成本的增加和辐射暴露的增加，计算机断层扫描（CT）的过度使用成为一个日益严重的公共卫生问题；这些必须与 CT 改善诊断和治疗计划的潜在益处相权衡。本研究的目的是确定全国范围内急诊科（ED）疑似尿路结石评估中 CT 和超声（US）使用的趋势，以及这些趋势是否伴随着尿路结石或其他重要疾病的诊断率和住院率的变化。
这是一项对 1996 年至 2007 年国家医院门诊医疗保健调查（NHAMCS）中 ED 就诊的回顾性横断面分析。作者确定了因侧腹或肾痛接受 CT 或 US 检查的患者就诊比例，并计算了尿路结石和其他重要疾病的诊断和住院率。检查了与 CT 使用相关的患者特异性和医院水平变量。
在研究期间，疑似尿路结石患者接受 CT 检查的比例从 4.0%增加到 42.5%（p < 0.001）。相比之下，US 的使用率一直较低，约为 5%，直到 2005 年至 2007 年开始下降至 2.4%（p = 0.01）。诊断为尿路结石的患者比例（约 18%，p = 0.55）、诊断为其他重要疾病的患者比例（p > 0.05）和住院患者比例（约 11%，p = 0.49）没有显著变化。以下特征与接受 CT 扫描的可能性更高相关：男性（优势比[OR] = 1.83，95%置信区间[CI] = 1.22 至 2.77）、出现严重疼痛（OR = 2.96，95% CI = 1.14 至 7.65）和分诊在 15 分钟或更短时间内（OR = 2.41，95% CI = 1.08 至 5.37）。在农村医院就诊的患者（vs. 城市地区；OR = 0.34，95% CI = 0.19 至 0.61）和由非医师医疗保健提供者管理的患者（OR = 0.19，95% CI = 0.07 至 0.53）的 CT 使用率较低。
从 1996 年到 2007 年，疑似肾结石患者 CT 扫描的使用率增加了 10 倍，但肾结石、其他重要替代诊断的诊断率或住院率没有相应变化。
