Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America.
PLoS One. 2020 Sep 16;15(9):e0239059. doi: 10.1371/journal.pone.0239059. eCollection 2020.
The proportion of US emergency department (ED) visits that lead to hospitalization has declined over time. The degree to which advanced imaging use contributed to this trend is unknown. Our objective was to examine the association between advanced imaging use during ED visits and changes in ED hospitalization rates between 2007-2008 and 2015-2016.
We analyzed data from the National Hospital Ambulatory Medical Care Survey. The primary outcome was ED hospitalization, including admission to inpatient and observation units and outside transfers. The primary exposure was advanced imaging during the ED visit, including computed tomography, magnetic resonance imaging, and ultrasound. We constructed a survey-weighted multivariable logistic regression with binary outcome of ED hospitalization to examine changes in adjusted hospitalization rates from 2007-2008 to 2015-2016, comparing ED visits with and without advanced imaging.
ED patients who received advanced imaging (versus those who did not) were more likely to be 65 years or older (25.3% vs 13.0%), non-Hispanic white (65.3% vs 58.5%), female (58.4% vs 54.1%), and have Medicare (26.5% vs 16.0%). Among ED visits with advanced imaging, adjusted annual hospitalization rate declined from 22.5% in 2007-2008 to 17.3% (adjusted risk ratio [aRR] 0.77; 95% CI 0.68, 0.86) in 2015-2016. In the same periods, among ED visits without advanced imaging, adjusted annual hospitalization rate declined from 14.3% to 11.6% (aRR 0.81; 95% CI 0.73, 0.90). The aRRs between ED visits with and without advanced imaging were not significantly different.
From 2007-2016, ED visits with advanced imaging did not have a greater reduction in admission rate compared to those without advanced imaging. Our results suggest that increasing advanced imaging use likely had a limited role in the general decline in hospital admissions from EDs. Future research is needed to further validate this finding.
美国急诊科（ED）就诊后住院的比例随时间推移呈下降趋势。先进影像学检查的应用在多大程度上促成了这一趋势尚不清楚。我们的目的是研究 ED 就诊期间先进影像学检查的使用与 2007-2008 年至 2015-2016 年期间 ED 住院率变化之间的关系。
我们分析了国家医院门诊医疗调查数据。主要结局为 ED 住院，包括住院和观察病房以及院外转科。主要暴露因素为 ED 就诊期间的先进影像学检查，包括计算机断层扫描、磁共振成像和超声检查。我们构建了一个基于调查权重的多变量逻辑回归模型，以二元结局 ED 住院来检验 2007-2008 年至 2015-2016 年期间调整后住院率的变化，比较有和无先进影像学检查的 ED 就诊。
接受先进影像学检查（与未接受者相比）的 ED 患者更可能为 65 岁或以上（25.3%比 13.0%）、非西班牙裔白人（65.3%比 58.5%）、女性（58.4%比 54.1%）和拥有医疗保险（26.5%比 16.0%）。在有先进影像学检查的 ED 就诊中，调整后的年住院率从 2007-2008 年的 22.5%下降至 2015-2016 年的 17.3%（调整风险比[aRR]0.77；95%置信区间[CI]0.68,0.86）。同期，在无先进影像学检查的 ED 就诊中，调整后的年住院率从 14.3%下降至 11.6%（aRR 0.81；95%CI 0.73,0.90）。有和无先进影像学检查的 ED 就诊之间的 aRR 无显著差异。
从 2007-2016 年，有先进影像学检查的 ED 就诊的入院率下降幅度并不大于无先进影像学检查的就诊。我们的结果表明，先进影像学检查的广泛应用可能在急诊科总体住院人数下降中作用有限。需要进一步的研究来验证这一发现。
