Runde Daniel, Shah Kaushal, Naraghi Leily, Godbout Brandon, Kirschner Jonathan, Newman David, Wiener Dan, Lee Jarone
Department of Emergency Medicine, Harbor-UCLA Medical Center, David Geffen School of Medicine UCLA, Box 21, 1000, W Carson St. Torrance, Los Angeles, CA, 90509-2910, USA,
Emerg Radiol. 2014 Oct;21(5):473-8. doi: 10.1007/s10140-014-1217-1. Epub 2014 Apr 12.
The convenience of a computed tomography (CT) scanner in the emergency department (ED) may impact utilization rates. Our primary aim was to determine the rate of utilization before and after the placement of an ED CT scanner. Secondary aims were to determine the rate of utilization by anatomic region and during a 5-month period when the ED scanner was unavailable. We performed an electronic chart review of our ED with an annual census of 70,000 patients. We identified all patients over the age of 21 who had a CT scan performed from January 2008 to October 2010. Predetermined data elements were extracted by trained, hypothesis-blinded abstractors. Comparisons overall and within scan subtype were performed using seasonal matching. We found a CT utilization rate of 114 per 1,000 patient visits before and 139 per 1,000 patient visits after the placement of a CT scanner in the ED (p<0.0001). Linear regression analysis found a line with a slope of β=0.114 (95 % CI=0.107-0.121) and an R2 of 0.508. CT rates increased in the following regions: head CTs by 14 per 1,000 visits (p<0.0001); neck CTs by 3 per 1,000 visits (p<0.0001); abdomen/pelvis CTs by 4 per 1,000 visits (p=0.0015); "other" CTs by 2 per 1,000 visits (p<0.0001). Increased rates of chest and facial CTs approached significance with p values of 0.05. During the 5-month downtime, utilization remained unchanged at 141 per 1,000 visits (p=0.38). Overall CT utilization increased after the placement of a scanner in the ED. Most subtypes of scan increased. Utilization was unchanged during a period of ED scanner unavailability, suggesting that increased utilization may be difficult to reverse.
急诊科（ED）配备计算机断层扫描（CT）扫描仪的便利性可能会影响其使用率。我们的主要目的是确定在急诊科安置CT扫描仪前后的使用率。次要目的是确定按解剖区域以及在急诊科扫描仪无法使用的5个月期间的使用率。我们对年接诊量为70000名患者的急诊科进行了电子病历审查。我们确定了2008年1月至2010年10月期间所有接受CT扫描的21岁以上患者。由经过培训、对假设不知情的提取人员提取预定的数据元素。使用季节性匹配进行总体和扫描亚型内的比较。我们发现，在急诊科安置CT扫描仪之前，CT使用率为每1000次患者就诊114例，之后为每1000次患者就诊139例（p<0.0001）。线性回归分析发现一条斜率为β=0.114（95%CI=0.107-0.121）且R2为0.508的直线。以下区域的CT使用率有所增加：头部CT每1000次就诊增加14例（p<0.0001）；颈部CT每1000次就诊增加3例（p<0.0001）；腹部/盆腔CT每1000次就诊增加4例（p=0.0015）；“其他”CT每1000次就诊增加2例（p<0.0001）。胸部和面部CT使用率的增加接近显著水平，p值为0.05。在5个月的停机期间，使用率保持不变，为每1000次就诊141例（p=0.38）。在急诊科安置扫描仪后，总体CT使用率有所增加。大多数扫描亚型都有所增加。在急诊科扫描仪无法使用期间，使用率保持不变，这表明使用率的增加可能难以逆转。
