Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, New York, New York.
Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
J Am Coll Radiol. 2017 Oct;14(10):1282-1290. doi: 10.1016/j.jacr.2017.03.004. Epub 2017 May 5.
To use patient-generated data to assess the changing role of emergency department (ED) imaging for a spectrum of clinical indications.
The Household Component Emergency Room Visits File was obtained from 1996 through 2014 for the Medical Expenditure Panel Survey, a nationally representative survey of US households. Percentage of visits associated with various imaging modalities was computed annually, stratified by respondents' self-reported primary condition during the visit. Modality characteristics were assessed for conditions most frequently imaged in 1996 or 2014.
For most conditions, use of advanced imaging (defined by Medical Expenditure Panel Survey as CT or MRI) in the ED increased significantly (P < .001). The largest growth occurred for urinary calculus (from 0% to 48.5%) and headache (from 17.5% to 33.3%), which were the most commonly imaged conditions by CT or MRI in 2014. For ultrasound, the most commonly imaged condition was pregnancy in 1996 (32.9%) and 2014 (44.5%). No other condition was associated with ultrasound in >20% of visits. For radiography, the most commonly imaged conditions were extremity wounds and fractures in 1996 (range 84.5%-90.2%) and 2014 (range 93.4%-93.9%). Use of radiography decreased for urinary calculus from 67.4% to 24.2% (P < .001).
For many conditions, ED utilization of advanced imaging increased significantly, though growth was variable across conditions. In certain scenarios, advanced ED imaging is adding to, rather than replacing, other modalities. Ultrasound and radiography utilization was overall unchanged. That national patient survey data mirror traditional claims-based studies suggests an expanded role for patient-generated data in identifying areas of imaging utilization that may benefit from targeted optimization efforts.
利用患者生成的数据来评估急诊部（ED）影像在一系列临床适应证中的作用变化。
从 1996 年至 2014 年，通过对美国家庭进行的全国代表性调查——医疗支出面板调查（MEPS），获得家庭组成部分急诊就诊档案。每年按受访者在就诊期间报告的主要疾病对各种影像方式的就诊比例进行分层计算。对 1996 年或 2014 年最常进行影像学检查的疾病的检查方式特征进行评估。
对于大多数疾病，ED 中高级影像学（MEPS 将其定义为 CT 或 MRI）的使用显著增加（P <.001）。增长最大的是尿路结石（从 0%增加到 48.5%）和头痛（从 17.5%增加到 33.3%），这两种疾病在 2014 年是最常通过 CT 或 MRI 进行影像学检查的疾病。对于超声检查，最常进行影像学检查的疾病是妊娠，1996 年和 2014 年的比例分别为 32.9%和 44.5%。没有其他疾病在超过 20%的就诊中与超声检查相关。对于 X 线摄影，1996 年和 2014 年最常进行影像学检查的疾病是四肢伤口和骨折，比例分别为 84.5%-90.2%和 93.4%-93.9%。尿路结石的 X 线摄影使用率从 67.4%降至 24.2%（P <.001）。
对于许多疾病，ED 中高级影像学的使用显著增加，尽管不同疾病的增长情况有所不同。在某些情况下，ED 中的高级影像学检查是在增加而不是替代其他检查方式。超声和 X 线摄影的使用率总体保持不变。国家患者调查数据与传统的基于索赔的研究结果一致，这表明患者生成的数据在确定可能受益于有针对性的优化工作的影像学应用领域方面具有广泛的作用。
