重症监护病房中先进成像技术的使用减少，导致费用降低，且对患者预后无负面影响。

Advanced imaging use in intensive care units has decreased, resulting in lower charges without negative effects on patient outcomes.

作者信息

Lee Jarone, Geyer Brian, Naraghi Leily, Kaafarani Haytham M A, Eikermann Matthias, Yeh D Dante, Bajwa Ednan K, Cobb J Perren, Raja Ali S

机构信息

Departments of Surgery and Emergency Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, MA.

Department of Emergency Medicine, Brigham and Women's Hospital and Massachusetts General Hospital, Boston, MA.

出版信息

J Crit Care. 2015 Jun;30(3):460-4. doi: 10.1016/j.jcrc.2014.12.012. Epub 2014 Dec 24.

DOI:10.1016/j.jcrc.2014.12.012

PMID:25596998

Abstract

PURPOSE

There has been both greater recognition and scrutiny of the increased use of advanced imaging. Our aim was to determine whether there has been a change over time in the use of computed tomography (CT), magnetic resonance imaging (MRI), ultrasound (US) modalities in the intensive care units (ICUs).

MATERIALS AND METHODS

A retrospective review of 75657 admissions to 20 ICUs was conducted. Results were analyzed with multivariate linear, negative binomial, and Poisson regressions. Primary outcomes were rates of use of CT, MRI, and US per 1000 ICU admissions every 6 months. Secondary outcomes were changes in radiology use associated with impacts on mortality, hospital length of stay (LOS), ICU LOS, and hospital charges.

RESULTS

The rate of imaging use decreased by 13.5% between 2007 and 2011 (incidence rate ratio [IRR], 0.982; P < .001). Most of this decrease was by CTs (21.0%; IRR, 0.973; P < .001). Use of MRI decreased by 6.0% (IRR, 0.991; P = .04), whereas US increased by 18.9% (IRR, 1.012; P < .001). The charges associated with imaging decreased by $74 per ICU admission, which would save an estimated $1.2 million in charges during 2011. Decreased imaging was not associated with changes in mortality, hospital, and ICU LOS.

CONCLUSION

Advanced imaging use decreased for 5 years in the ICUs, resulting in decreased charges without negative effects on patient outcomes.

摘要

目的

人们对先进成像技术使用的增加有了更多认识和审视。我们的目的是确定重症监护病房（ICU）中计算机断层扫描（CT）、磁共振成像（MRI）、超声（US）等检查手段的使用情况是否随时间发生了变化。

材料与方法

对20个ICU的75657例入院病例进行回顾性研究。采用多变量线性回归、负二项回归和泊松回归分析结果。主要结局指标是每6个月每1000例ICU入院患者中CT、MRI和US的使用频率。次要结局指标是与死亡率、住院时间（LOS）、ICU住院时间和住院费用影响相关的放射学检查使用情况的变化。

结果

2007年至2011年间，成像检查的使用率下降了13.5%（发病率比[IRR]，0.982；P < 0.001）。这种下降主要是CT检查导致的（下降21.0%；IRR，0.973；P < 0.001）。MRI的使用下降了6.0%（IRR，0.991；P = 0.04），而US的使用增加了18.9%（IRR，1.012；P < 0.001）。每次ICU入院的成像检查相关费用减少了74美元，2011年估计可节省120万美元的费用。成像检查的减少与死亡率、住院和ICU住院时间的变化无关。