Psoter Kevin J, Roudsari Bahman S, Vaughn Matthew, Fine Gabriel C, Jarvik Jeffrey G, Gunn Martin L
Department of Epidemiology, University of Washington, Seattle, Washington.
Department of Radiology, University of Washington, Seattle, Washington; Comparative Effectiveness, Cost and Outcomes Research Center, University of Washington, Seattle, Washington.
J Am Coll Radiol. 2014 Jun;11(6):616-22. doi: 10.1016/j.jacr.2013.02.014. Epub 2013 Jun 12.
The aim of this study was to evaluate the influence of an image-sharing network established between referring hospitals and a level I trauma center on CT utilization at the trauma center.
This retrospective study was approved by the local institutional review board. The requirement for informed consent was waived. Harborview Medical Center's trauma registry was linked to billing department data, and detailed information on all resources utilized during each patient's hospitalization was obtained. Negative binomial regression was used to evaluate body region-specific CT utilization between direct-admit and transfer patients after adjustment for potential confounding variables. Special attention was paid to 2005 as the year internet-based image sharing between Harborview Medical Center and referring hospitals was established.
A total of 81,159 trauma patients were admitted to Harborview Medical Center (44% transfers) during the study period. The utilization of head CT slightly increased from 1996 to 2005, with no significant difference between direct-admit and transfer patients. Between 2005 and 2010, utilization remained relatively unchanged; however, significantly higher utilization rates were observed for direct-admit patients. A relatively similar pattern was observed for pelvic CT; however, between 2005 and 2010, CT use was greater for direct-admit compared with transfer patients. Abdominal and thoracic CT was relatively unchanged between 2005 and 2010. However, both studies had significantly higher utilization rates for direct-admit patients.
The utilization rates of CT of different body regions have been higher for direct-admit trauma patients compared with transfer patients since 2005; however, decreasing utilization trends have been observed in recent years.
本研究旨在评估转诊医院与一级创伤中心之间建立的图像共享网络对创伤中心CT使用情况的影响。
本回顾性研究经当地机构审查委员会批准，豁免了知情同意的要求。哈博维尤医疗中心的创伤登记与计费部门数据相链接，获取了每位患者住院期间使用的所有资源的详细信息。采用负二项回归评估在调整潜在混杂变量后直接入院患者和转诊患者之间特定身体部位的CT使用情况。特别关注2005年，这一年哈博维尤医疗中心与转诊医院之间建立了基于互联网的图像共享。
在研究期间，共有81159名创伤患者入住哈博维尤医疗中心（44%为转诊患者）。1996年至2005年，头部CT的使用略有增加，直接入院患者和转诊患者之间无显著差异。2005年至2010年期间，使用率相对保持不变；然而，直接入院患者的使用率显著更高。骨盆CT观察到相对类似的模式；然而，2005年至2010年期间，直接入院患者的CT使用量高于转诊患者。2005年至2010年期间，腹部和胸部CT相对不变。然而，两项研究中直接入院患者的使用率均显著更高。
自2005年以来，直接入院创伤患者不同身体部位的CT使用率高于转诊患者；然而，近年来观察到使用率呈下降趋势。
