Hanna Tarek N, Rohatgi Saurabh, Shekhani Haris N, Dave Ishaan Amit, Johnson Jamlik-Omari
Division of Emergency Radiology, Department of Radiology and Imaging Sciences, Emory University Midtown Hospital, 550 Peachtree Road, Atlanta, GA, 30308, USA.
Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.
Emerg Radiol. 2017 Aug;24(4):361-367. doi: 10.1007/s10140-017-1488-4. Epub 2017 Feb 27.
The objective of this study was to evaluate the proportion of Emergency Department (ED) radiology examinations ordered or interpreted prior to a documented clinical assessment.
We collected 600 retrospective consecutive ED cases consisting equally of patients whose first ED imaging examination was computed tomography (CT), radiography (XR), or ultrasonography (US). For each patient, the following times were documented: ED arrival, ED departure, ED length of stay (LOS), imaging order entry, image availability, radiology report availability, triage note, ED provider note, and laboratory results.
Mean age was 44.2, 66.5% female, and mean ED LOS was 326.2 min. ED LOS was longer for patients who received CT versus XR (343.9 vs. 311.3; p = 0.029). In 25.5% of XR, 10% of CT, and 8% of US cases, the imaging exam was completed before the ED provider note was started. In 20.5% of XR, 6.5% of CT, and 6% of US cases, the radiologist did not have the ED provider note available prior to completing their diagnostic interpretation. In 33.4% of all cases and 57.5% of XR cases, incomplete clinical documentation (triage note, provider note, lab results) was available during radiology report creation. CT and US exams more frequently had clinical data available prior to radiologist interpretation than XR (p < 0.0001). Radiologist turn-around-time was unaffected by clinical information availability.
Eight percent of ED CT and 10% of ED US examinations were ordered and completed before documented clinical assessment. Thirty-three percent had incomplete clinical assessment performed prior to image interpretation. Further investigation is needed to determine impact on interpretation accuracy.
本研究的目的是评估在有记录的临床评估之前开具或解读的急诊科（ED）放射学检查的比例。
我们收集了600例回顾性连续的ED病例，这些病例平均分为三组，其首次ED影像学检查分别为计算机断层扫描（CT）、X线摄影（XR）或超声检查（US）。对于每位患者，记录以下时间：ED到达时间、ED离开时间、ED住院时间（LOS）、影像检查医嘱录入时间、图像可获取时间、放射学报告可获取时间、分诊记录、ED医生记录以及实验室检查结果。
平均年龄为44.2岁，女性占66.5%，平均ED住院时间为326.2分钟。接受CT检查的患者的ED住院时间比接受XR检查的患者更长（343.9分钟对311.3分钟；p = 0.029）。在25.5%的XR检查、10%的CT检查和8%的US检查病例中，影像学检查在ED医生记录开始之前就已完成。在20.5%的XR检查、6.5%的CT检查和6%的US检查病例中，放射科医生在完成诊断解读之前没有获取到ED医生记录。在所有病例的33.4%以及XR病例的57.5%中，在创建放射学报告期间存在不完整的临床记录（分诊记录、医生记录、实验室检查结果）。与XR相比，CT和US检查在放射科医生解读之前更频繁地有临床数据可用（p < 0.0001）。放射科医生的周转时间不受临床信息可用性的影响。
8%的ED CT检查和10%的ED US检查在有记录的临床评估之前就已开具并完成。33%的病例在图像解读之前进行了不完整的临床评估。需要进一步调查以确定其对解读准确性的影响。
