Director, Stroke and Vascular Imaging and Co-Director Neuroradiology Spine Intervention Service, Department of Radiology, University of Colorado Hospital, Aurora, Colorado.
Department of Biostatistics & Informatics, Colorado School of Public Health, Aurora, Colorado.
J Am Coll Radiol. 2021 Nov;18(11):1525-1531. doi: 10.1016/j.jacr.2021.07.003. Epub 2021 Jul 28.
Increasing emergency department (ED) compliance with transient ischemic attack (TIA) imaging guidelines has previously been demonstrated, along with a substantial rise in imaging utilization over the past decade. The purpose of this study was to characterize the most commonly used combinations of imaging studies during ED workup of TIA and to quantify prevalence of redundant imaging (RI).
TIA discharges from EDs in the United States from 2006 to 2017 were identified in the Nationwide Emergency Department Sample. Brain and neurovascular imaging obtained during the encounter was identified using Current Procedural Terminology codes. RI was defined as an ED encounter with any duplicate cross-sectional brain, brain-vascular, or neck-vascular imaging. Patient demographics and hospital characteristics were incorporated into a multivariable logistic regression analysis to identify significant associations with RI.
There were 184,870 discharges with TIA from EDs in 2017. RI (brain) was observed in 55,513 (30%) of encounters. RI (brain-vascular) and RI (neck-vascular) imaging was identified in 5,149 (2.8%) and 1,325 (0.7%) of encounters, respectively. Decreased odds of obtaining RI was observed in Medicaid patients (odds ratio [OR]: 0.72, 95% confidence interval [CI]: 0.64-0.81), non-trauma centers (OR: 0.49, 95% CI: 0.26-0.93), rural hospital locations (OR: 0.18, 95% CI: 0.11-0.29), and weekend encounters (OR: 0.9, 95% CI: 0.85-0.96). Trend analysis from 2006 to 2017 demonstrated a rise in RI (brain) from 2.3% of encounters in 2006 to 30% of encounters in 2017. RI for patients discharged from EDs with TIA in 2017 resulted in additional charges of approximately US$8,670,832.
Increased imaging utilization for TIA workup across EDs in the United States is associated with rising use of redundant imaging. We identify imaging practices that could be targeted to mitigate health care expenditures while adhering to TIA imaging guidelines.
先前已经证明，通过提高急诊科（ED）对短暂性脑缺血发作（TIA）影像学检查指南的遵循率，以及过去十年中影像学检查利用率的大幅提高。本研究的目的是描述 TIA 在 ED 检查中最常用的影像学检查组合，并量化冗余影像学（RI）的发生率。
在美国全国急诊部样本中，确定了 2006 年至 2017 年 ED 中 TIA 的出院病例。使用当前程序术语代码识别在就诊期间获得的脑和神经血管影像学。RI 定义为 ED 就诊时存在任何重复的脑、脑血管或颈部血管影像学检查。将患者人口统计学和医院特征纳入多变量逻辑回归分析，以确定与 RI 显著相关的因素。
2017 年，ED 中有 184870 例 TIA 出院病例。在 55513 例（30%）就诊中发现 RI（脑）。在 5149 例（2.8%）和 1325 例（0.7%）就诊中分别发现 RI（脑血管）和 RI（颈部血管）影像学检查。在 Medicaid 患者（优势比 [OR]：0.72，95%置信区间 [CI]：0.64-0.81）、非创伤中心（OR：0.49，95% CI：0.26-0.93）、农村医院（OR：0.18，95% CI：0.11-0.29）和周末就诊（OR：0.9，95% CI：0.85-0.96）中，获得 RI 的可能性降低。2006 年至 2017 年的趋势分析表明，RI（脑）从 2006 年的 2.3%就诊增加到 2017 年的 30%就诊。2017 年从 ED 出院的 TIA 患者进行 RI 检查，导致额外费用约为 8670832 美元。
美国 ED 对 TIA 检查的影像学检查利用率增加与重复影像学检查的使用增加有关。我们确定了可以针对这些影像学检查实践进行调整的方法，以减轻医疗支出，同时遵守 TIA 影像学检查指南。
