Health Economics and Data Analytics, Curtin University Bentley Campus, Perth, Western Australia, Australia.
Health Economics and Data Analytics, Curtin University Bentley Campus, Perth, Western Australia, Australia
BMJ Open. 2021 Mar 4;11(3):e043315. doi: 10.1136/bmjopen-2020-043315.
This study aimed to examine trends in number of CT scans requested by tertiary emergency department (ED) physicians in Western Australia (WA) from 2003 to 2015 across broad demographic and presentation characteristics, anatomical areas and presented symptoms.
An observational cross-sectional study over study period from 2003 to 2015.
Linked administrative health service data at individual level from WA.
A total of 1 666 884 tertiary hospital ED presentations of people aged 18 years or older were included in this study MAIN OUTCOME MEASURE: Number of CT scans requested by tertiary ED physicians in an ED presentation.
Poisson regression models were used to assess variation and trends in number of CT scans requested by ED physicians across demographic characteristics, clinical presentation characteristics and anatomical areas.
Over the entire study duration, 71 per 1000 ED episodes had a CT requested by tertiary ED physicians. Between 2003 and 2015, the rate of CT scanning almost doubled from 58 to 105 per 1000 ED presentations. After adjusted for all observed characteristics, the rate of CT scans showed a downward trend from 2009 to 2011 and subsequent increase. Males, older individuals, those attending ED as a result of pain, those with neurological symptoms or injury or with higher priority triage code were the most likely to have CT requested by tertiary ED physicians.
Noticeable changes in the number of CTs requested by tertiary ED physicians corresponded to the time frame of major health reforms happening within WA and nationally.
本研究旨在调查 2003 年至 2015 年期间，西澳大利亚州（WA）三级急诊部（ED）医生要求进行 CT 扫描的数量趋势，涉及广泛的人口统计学和表现特征、解剖区域和表现症状。
这是一项观察性的横断面研究，研究期间为 2003 年至 2015 年。
来自 WA 的个体水平的医疗服务行政数据。
本研究共纳入 1666884 名年龄在 18 岁或以上的三级医院 ED 就诊者。
ED 就诊者中 ED 医生要求进行 CT 扫描的数量。
使用泊松回归模型评估 ED 医生在人口统计学特征、临床表现特征和解剖区域中要求进行 CT 扫描的数量的变化和趋势。
在整个研究期间，每 1000 例 ED 病例中有 71 例有 CT 要求。在 2003 年至 2015 年间，CT 扫描率几乎翻了一番，从每 1000 例 ED 就诊 58 例增至 105 例。在调整了所有观察到的特征后，CT 扫描率从 2009 年至 2011 年呈下降趋势，随后又有所增加。男性、年龄较大的个体、因疼痛就诊的个体、有神经系统症状或损伤或有较高优先级分诊代码的个体最有可能被三级 ED 医生要求进行 CT 扫描。
三级 ED 医生要求进行 CT 的数量发生了显著变化，与 WA 和全国范围内发生的重大卫生改革时间框架相吻合。
