Mid-South Imaging and Therapeutics, Memphis, Tennessee 38120, USA.
J Am Coll Radiol. 2012 Jun;9(6):409-13. doi: 10.1016/j.jacr.2012.01.011.
The aim of this study was to assess the association of patient encounter complexity and the utilization of CT of the abdomen and pelvis (CTAP) in the emergency department (ED) setting.
Using 5% research identifiable files for 2007, ED visits for Medicare fee-for-service beneficiaries were identified. Contemporaneous ED physician evaluation and management codes were used as the basis for patient complexity categorization. Encounters in which CTAP was performed on the same date of service were identified, and variables affecting the utilization of CTAP were analyzed.
Of 1,081,000 ED encounters, 306,401 (28.3%) were of lower complexity and 774,599 (71.7%) were of higher complexity. CT of the abdomen and pelvis was performed in 65,273 of all encounters (6.0%), corresponding to 4,069 (1.3%) of lower complexity and 61,204 (7.9%) of higher complexity encounters (odds ratio, 5.95; 95% confidence interval, 5.76-6.14). Of the 65,273 ED encounters associated with CTAP, 61,204 (93.8%) were of higher complexity.
Of patients undergoing CTAP in the ED setting, a very large majority (93.8%) are clinically complex. CT of the abdomen and pelvis is 5.95 times more likely to be utilized in higher than lower complexity ED patient encounters.
本研究旨在评估患者就诊复杂性与腹部和骨盆 CT（CTAP）在急诊科（ED）应用之间的关联。
利用 2007 年 5%可识别研究文件，确定了 Medicare 按服务收费受益人的 ED 就诊情况。同时性 ED 医师评估和管理代码被用作患者复杂程度分类的基础。确定了在服务当日实施 CTAP 的就诊情况，并分析了影响 CTAP 应用的变量。
在 1,081,000 例 ED 就诊中，306,401 例（28.3%）为低复杂度，774,599 例（71.7%）为高复杂度。所有就诊中，腹部和骨盆 CT 共实施了 65,273 例（6.0%），对应低复杂度就诊 4,069 例（1.3%）和高复杂度就诊 61,204 例（7.9%）（比值比，5.95；95%置信区间，5.76-6.14）。在与 CTAP 相关的 65,273 例 ED 就诊中，61,204 例（93.8%）为高复杂度。
在 ED 实施 CTAP 的患者中，绝大多数（93.8%）为临床复杂患者。CTAP 在高复杂度 ED 患者就诊中应用的可能性是低复杂度就诊的 5.95 倍。
