Hanna Tarek N, Kundu Suprateek, Singh Kush, Horný Michal, Wood Daniel, Prater Adam, Duszak Richard
Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road NE, Atlanta, GA, 30322, USA.
Division of Emergency and Trauma Imaging, Department of Radiology and Imaging Sciences, Emory University Midtown Hospital, 550 Peachtree Road, Atlanta, GA, 30308, USA.
Emerg Radiol. 2019 Apr;26(2):161-168. doi: 10.1007/s10140-018-1659-y. Epub 2018 Nov 15.
To identify and characterize the most frequent users of emergency department (ED) imaging.
All patients with at least one ED visit in 2016 across a four-hospital healthcare system were retrospectively identified and their ED imaging utilization characterized.
Overall, 126,940 unique patients underwent 187,603 ED visits (mean 1.5 ± 1.7) and a total of 192,142 imaging examinations (mean 1.7 ± 2.7). Fifty-eight percent of patients were imaged (73,672) and underwent a mean 2.6 ± 2.7 exams. When ranked by ED visits, 1.6% (2007) of patients had ≥ 4 ED visits (mean 6.1 ± 5.4). These ED "clinical superusers" accounted for 7.7% (14,409) of total ED visits and underwent 6.8 ± 5.4 imaging examinations, while non-superusers underwent 1.5 ± 2.2 (p < 0.01). When ranked by ED imaging utilization, 12.3% (15,575) of patients underwent ≥ 4 ED imaging examinations and consumed 49.5% (95,053) of all imaging services. A subset of just 1.3% (1608) of ED patients underwent > 10 annual ED examinations (ED "imaging superusers") and accounted for 12.4% (23,787) of all ED imaging services. Only 0.4% (n = 472) of patients were both clinical and imaging superusers. Despite similar ED visits to clinical superusers (6.0 ± 5.6 vs. 6.1 ± 5.4, p = 0.92), imaging superusers underwent significantly more imaging (14.8 ± 4.8 vs. 6.8 ± 5.4 examinations, p < 0.01).
Just 12% of ED patients consume 50% of all ED imaging services, and 1.3% consume 12.4%. These ED imaging superusers represent a distinct group from clinical superusers. Prospective identification of this newly described subgroup might permit targeted interventions to control ED imaging volume, restrain costs, and minimize per-patient radiation exposure.
识别并描述急诊科（ED）影像学检查的最频繁使用者。
回顾性确定2016年在一个由四家医院组成的医疗系统中至少有一次急诊科就诊经历的所有患者，并对其急诊科影像学检查的使用情况进行描述。
总体而言，126,940名不同患者进行了187,603次急诊科就诊（平均1.5±1.7次），共进行了192,142次影像学检查（平均1.7±2.7次）。58%的患者接受了影像学检查（73,672例），平均进行了2.6±2.7次检查。按急诊科就诊次数排序，1.6%（2007例）的患者急诊科就诊次数≥4次（平均6.1±5.4次）。这些急诊科“临床超级使用者”占急诊科就诊总数的7.7%（14,409次），接受了6.8±5.4次影像学检查，而非超级使用者接受了1.5±2.2次检查（p<0.01）。按急诊科影像学检查使用情况排序，12.3%（15,575例）的患者进行了≥4次急诊科影像学检查，消耗了所有影像学服务的49.5%（95,053次）。仅1.3%（1608例）的急诊科患者每年进行>10次急诊科检查（急诊科“影像学超级使用者”），占所有急诊科影像学服务的12.4%（23,787次）。只有0.4%（n = 472）的患者既是临床超级使用者又是影像学超级使用者。尽管影像学超级使用者与临床超级使用者的急诊科就诊次数相似（6.0±5.6次对6.1±5.4次，p = 0.92），但影像学超级使用者接受的影像学检查明显更多（14.8±4.8次对6.8±5.4次检查，p<0.01）。
仅12%的急诊科患者消耗了所有急诊科影像学服务的50%，1.3%的患者消耗了12.4%。这些急诊科影像学超级使用者是与临床超级使用者不同的群体。对这个新描述的亚组进行前瞻性识别可能有助于采取有针对性的干预措施，以控制急诊科影像学检查量、控制成本并尽量减少每位患者的辐射暴露。
