Gundareddy Venkat P, Maruthur Nisa M, Chibungu Abednego, Bollampally Preetam, Landis Regina, Eid Shaker M
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore MD; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD.
J Hosp Med. 2017 May;12(5):323-328. doi: 10.12788/jhm.2722.
Increasing use of testing among hospitalized patients has resulted in an increase in radiologic incidental findings (IFs), which challenge the provision of high-value care in the hospital setting.
To understand impact of radiologic incidental findings on resource utilization in patients hospitalized with chest pain.
Retrospective observational cross sectional study.
Academic medical center.
Adult patients hospitalized with principal diagnosis of chest pain.
Demographic, imaging, and length of stay (LOS) data were abstracted from the medical charts. We used multiple logistic regression to evaluate factors associated with radiologic IFs and negative binomial regression to evaluate the association between radiologic IFs and LOS.
1811 consecutive admissions with chest pain were analyzed retrospectively over a period of 24 months; 376 patients were included in the study after exclusion criteria were applied and readmissions removed. Of these, 197 patients (52%) had 364 new radiologic IFs on imaging; most IFs were of minor (50%) or moderate clinical significance (42%), with only 7% of major significance. Odds of finding radiologic IFs increased with age (adjusted odds ratio, 1.04; 95% confidence interval [CI], 1.01-1.06) and was associated with a 26% increase in LOS (adjusted incidence rate ratio, 1.26; 95% CI, 1.07-1.49).
Radiologic IFs were very common among patients hospitalized with chest pain of suspected cardiac origin and independently associated with an increase in the LOS. Interventions to address radiologic IFs may reduce LOS and, thereby, support high-value care. Journal of Hospital Medicine 2017;12:323-328.
住院患者检查的使用增加导致了放射学偶然发现（IFs）增多，这对医院环境中高价值医疗服务的提供构成了挑战。
了解放射学偶然发现在胸痛住院患者资源利用方面的影响。
回顾性观察性横断面研究。
学术医疗中心。
以胸痛为主诊断的成年住院患者。
从病历中提取人口统计学、影像学和住院时间（LOS）数据。我们使用多元逻辑回归评估与放射学IFs相关的因素，并使用负二项回归评估放射学IFs与LOS之间的关联。
在24个月期间对1811例连续的胸痛入院病例进行了回顾性分析；应用排除标准并去除再次入院病例后，376例患者纳入研究。其中，197例患者（52%）在影像学检查中有364项新的放射学IFs；大多数IFs具有轻微（50%）或中度临床意义（42%），只有7%具有重大意义。发现放射学IFs的几率随年龄增加而升高（调整后的优势比，1.04；95%置信区间[CI]，1.01 - 1.06），并且与LOS增加26%相关（调整后的发病率比，1.26；95%CI，1.07 - 1.49）。
放射学IFs在疑似心脏来源胸痛的住院患者中非常常见，并且与LOS增加独立相关。针对放射学IFs的干预措施可能会缩短LOS，从而支持高价值医疗服务。《医院医学杂志》2017年；12：323 - 328。
