1994 年至 2015 年美国急诊部门胸部成像利用率的增加。
Increasing Utilization of Chest Imaging in US Emergency Departments From 1994 to 2015.
机构信息
Department of Radiology, University of Chicago Medical Center, Chicago, Illinois.
Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
出版信息
J Am Coll Radiol. 2019 May;16(5):674-682. doi: 10.1016/j.jacr.2018.11.011. Epub 2019 Jan 2.
PURPOSE
The aim of this study was to assess national and state-specific changes in emergency department (ED) chest imaging utilization from 1994 to 2015.
METHODS
Using aggregate 100% Medicare Physician/Supplier Procedure Summary Master Files for 1994 to 2015, the annual frequency of chest imaging in Medicare Part B beneficiaries in the ED setting was identified, and utilization was normalized to annual Medicare enrollment as well as annual ED visits. Using individual Medicare beneficiary 5% research-identifiable files, similar determinations were performed for each state.
RESULTS
Between 1994 and 2015, per 1,000 beneficiaries, ED utilization of chest radiography and CT increased by 173% (compound annual growth rate [CAGR] 4.9%) and 5,941.8% (CAGR 21.6%). Per 1,000 ED visits, utilization increased by 81% (CAGR 2.9%) and 3,915.4% (CAGR 19.2%), respectively. Across states, utilization was highly variable, with 2015 radiography utilization per 1,000 ED visits ranging from 82 (Wyoming) to 731 (Hawaii) and CT utilization ranging from 18 (Wyoming) to 76 (Hawaii). Between 2004 and 2015, most states demonstrated increases in the utilization of both radiography (maximal increase of CAGR 11.0% in Vermont) and CT (maximal increase of CAGR 21.0% in Maine). Nonetheless, utilization of radiography declined in four states and utilization of CT in a single state.
CONCLUSIONS
Over the past two decades, ED utilization of chest imaging has increased. This was related not only to an increasing frequency of ED visits but also to increasing utilization per ED visit. Across states, utilization is highly variable, but with radiography and CT both increasing, the use of CT seems additive to, rather than replacing, radiography.
目的
本研究旨在评估 1994 年至 2015 年期间，急诊部（ED）胸部成像利用的国家和州特定变化。
方法
使用 1994 年至 2015 年的 Medicare 医师/供应商程序摘要总文件的聚合 100％，确定 Medicare Part B 受益人在 ED 环境中胸部成像的年度频率，并将利用率标准化为年度 Medicare 注册人数以及年度 ED 就诊次数。使用 Medicare 每位受益人的 5％研究可识别文件，对每个州进行类似的确定。
结果
在 1994 年至 2015 年期间，每 1000 名受益人的 ED 胸部 X 线摄影和 CT 使用率分别增加了 173％（复合年增长率[CAGR]为 4.9％）和 5941.8％（CAGR 为 21.6％）。每 1000 次 ED 就诊，使用率分别增加了 81％（CAGR 为 2.9％）和 3915.4％（CAGR 为 19.2％）。在各州之间，利用率差异很大，2015 年每 1000 次 ED 就诊的 X 射线摄影利用率范围从 82（怀俄明州）到 731（夏威夷州），CT 利用率范围从 18（怀俄明州）到 76（夏威夷州）。在 2004 年至 2015 年期间，大多数州的 X 射线摄影（佛蒙特州的最大增长率为 CAGR 11.0％）和 CT（缅因州的最大增长率为 CAGR 21.0％）的利用率均有所增加。尽管如此，四个州的 X 射线摄影利用率下降，一个州的 CT 利用率下降。
结论
在过去的二十年中，ED 胸部成像的利用率有所增加。这不仅与 ED 就诊频率的增加有关，还与每次 ED 就诊的利用率增加有关。在各州之间，利用率差异很大，但 X 射线摄影和 CT 均在增加，CT 的使用似乎是对 X 射线摄影的补充，而不是替代。
Zotero 插件