Prabhakar Anand M, Misono Alexander S, Harvey H Benjamin, Yun Brian J, Saini Sanjay, Oklu Rahmi
Division of Cardiovascular Imaging and Emergency Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Am J Emerg Med. 2015 Aug;33(8):1076-9. doi: 10.1016/j.ajem.2015.04.025. Epub 2015 Apr 22.
This study aims to determine the use of diagnostic imaging in emergency department (ED) observation units, particularly relative to inpatients admitted from the ED.
Retrospective, descriptive analysis.
Our database of ED patients was retrospectively reviewed to identify patients managed in the observation unit or admitted to inpatient services. In February 2014, we randomly selected 105 ED observation patients and 108 patients admitted to inpatient services from the ED. Electronic medical records were reviewed to assess diagnosis as well as type and quantity of imaging tests obtained.
Eighty (76%) ED observation patients underwent imaging tests (radiographs, 39%; computed tomography, 25%; magnetic resonance imaging (MRI), 24%; ultrasound, 8%; other, 4%); 85 inpatients (79%) underwent imaging tests while in the ED (radiographs, 52%; computed tomography, 30%; MRI, 8%; ultrasound, 9%; other, 1%). There was no significant difference in overall imaging use between ED observation patients and inpatients, but ED observation patients were more likely to undergo MRI (P=.0243). The most common presenting diagnoses to the ED observation unit were neurologic complaints (25%), abdominal pain (17%), and cardiac symptoms (16%).
There is no difference in the overall use of imaging in patients transferred to the ED observation unit vs those directly admitted from the ED. However, because ED observation unit patients tend to be accountable for a higher proportion of their health care bill, the impact of imaging in these patients is likely substantive.
本研究旨在确定急诊观察病房中诊断性影像学检查的使用情况，尤其是相对于从急诊室收治的住院患者而言。
回顾性描述性分析。
对我们的急诊患者数据库进行回顾性审查，以确定在观察病房接受治疗或收治入院的患者。2014年2月，我们从急诊观察病房随机选取了105名患者和108名从急诊室收治入院的患者。对电子病历进行审查，以评估诊断情况以及所进行的影像学检查的类型和数量。
80名（76%）急诊观察病房患者接受了影像学检查（X光片，39%；计算机断层扫描，25%；磁共振成像（MRI），24%；超声，8%；其他，4%）；85名住院患者（79%）在急诊室期间接受了影像学检查（X光片，52%；计算机断层扫描，30%；MRI，8%；超声，9%；其他，1%）。急诊观察病房患者和住院患者在总体影像学检查使用方面无显著差异，但急诊观察病房患者更有可能接受MRI检查（P = 0.02）。急诊观察病房最常见的就诊诊断为神经症状（25%）、腹痛（17%）和心脏症状（16%）。
转入急诊观察病房的患者与直接从急诊室收治的患者在影像学检查的总体使用上没有差异。然而，由于急诊观察病房患者往往要承担更高比例的医疗费用，影像学检查对这些患者的影响可能很大。
