Bellolio M Fernanda, Heien Herbert C, Sangaralingham Lindsey R, Jeffery Molly M, Campbell Ronna L, Cabrera Daniel, Shah Nilay D, Hess Erik P
Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota.
Mayo Clinic, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota.
West J Emerg Med. 2017 Aug;18(5):835-845. doi: 10.5811/westjem.2017.5.34152. Epub 2017 Jul 19.
Our goal was to investigate trends in computed tomography (CT) utilization in emergency departments (EDs) and its association with hospitalization.
We conducted an analysis of an administrative claims database of U.S. privately insured and Medicare Advantage enrollees. We identified ED visits from 2005 through 2013 and assessed for CT use, associated factors, and hospitalization after CT, along with patient demographics. We used both descriptive methods and regression models adjusted for year, age, sex, race, geographic region, and Hwang comorbidity score to explore associations among CT use, year, demographic characteristics, and hospitalization.
We identified 33,144,233 ED visits; 5,901,603 (17.8%) involved CT. Over time, CT use during ED visits increased 59.9%. CT use increased in all age groups but decreased in children since 2010. In propensity-matching analysis, odds of hospitalization increased with age, comorbidities, male sex, and CT use (odds ratio, 2.38). Odds of hospitalization over time decreased more quickly for patients with CT.
CT utilization in the ED has increased significantly from 2005 through 2013. For children, CT use after 2010 decreased, indicating caution about CT use. Male sex, older age, and higher number of comorbidities were predictors of CT in the ED. Over time, odds of hospitalization decreased more quickly for patients with CT.
我们的目标是调查急诊科计算机断层扫描（CT）的使用趋势及其与住院治疗的关联。
我们对美国私人保险和医疗保险优势参保者的行政索赔数据库进行了分析。我们确定了2005年至2013年期间的急诊就诊情况，并评估了CT的使用情况、相关因素以及CT检查后的住院情况，同时还考虑了患者的人口统计学特征。我们使用描述性方法和针对年份、年龄、性别、种族、地理区域和黄氏共病评分进行调整的回归模型，以探讨CT使用、年份、人口统计学特征和住院治疗之间的关联。
我们确定了33144233次急诊就诊；其中5901603次（17.8%）涉及CT检查。随着时间的推移，急诊就诊期间CT的使用增加了59.9%。所有年龄组的CT使用量均有所增加，但自2010年以来儿童的CT使用量有所下降。在倾向匹配分析中，住院几率随着年龄、共病、男性性别和CT使用情况的增加而增加（优势比为2.38）。随着时间的推移，接受CT检查的患者住院几率下降得更快。
从2005年到2013年，急诊科的CT使用量显著增加。对于儿童，2010年后CT的使用量有所下降，这表明在CT使用方面需谨慎。男性、年龄较大和共病数量较多是急诊科使用CT的预测因素。随着时间的推移，接受CT检查的患者住院几率下降得更快。
