Department of Radiology and Biomedical Imaging, Yale School of Medicine, PO Box 208042, Tompkin's East 2, New Haven, CT 06520.
Department of Emergency Medicine, Yale School of Medicine, New Haven, CT.
AJR Am J Roentgenol. 2022 Mar;218(3):544-551. doi: 10.2214/AJR.21.26543. Epub 2021 Sep 29.
Utilization of head and neck CTA in the emergency department (ED) has grown disproportionately to other neuroimaging examinations. The purpose of this article was to characterize utilization of head and neck CTA in the ED, comparing utilization and frequency of nonroutine results communication among patients' chief concerns. All adult ED visits for a single health care system from January 2014 to December 2017 were retrospectively reviewed. Variables recorded included chief concerns, whether head and neck CTA was performed, and, if so, whether the report documented nonroutine results communication. The 50 chief concerns resulting in the highest number of head and neck CTA examinations were identified. Frequencies of head and neck CTA ordering and of nonroutine results communication were calculated. A subset of reports documenting nonroutine communication were manually reviewed. Head and neck CTA was ordered in 2.5% (17,903) of 708,145 ED visits in 236,476 patients (mean age, 49.8 ± 20.5 [SD] years; 110,952 men, 125,521 women, 3 unknown sex). Head and neck CTA was ordered for 833 distinct chief concerns. Nonroutine results communication was documented for 17.6% (3155/17,903) of examinations. Among the 50 chief concerns associated with the highest number of examinations, frequency of ordering head and neck CTA ranged from less than 0.5% (five concerns) to 55.2% (stroke code), and frequency of nonroutine communication ranged from 5.6% (transient ischemic attack) to 67.5% (unresponsive). Chief concerns not among the 50 most common accounted for 50.0% (8956/17,903) of examinations; these exhibited a collective frequency of nonroutine communication of 4.8% (429/8956). Manual review of 11.1% (350/3155) of reports with a nonroutine communication indicated an acute finding related to the indication in 51.1%, nonemergent but potentially explanatory finding in 14.0%, incidental finding in 28.0%, and communication of negative results in 6.9%. Head and neck CTA is ordered in 2.5% of ED visits for a wide range of chief concerns. Frequencies of ordering and of nonroutine results communication are highly variable among chief concerns. Acute indication-related findings account for half of nonroutine radiologist communications. Insight into patterns regarding head and neck CTA ordering and nonroutine results may help optimize patient selection and radiologist communications in the ED setting.
头颈部 CTA 在急诊科（ED）的应用呈不成比例地增长，超过了其他神经影像学检查。本文旨在描述头颈部 CTA 在急诊科的应用情况，比较不同主要就诊关注点患者中非例行结果沟通的应用和频率。回顾了 2014 年 1 月至 2017 年 12 月期间单一医疗系统内所有成人 ED 就诊情况。记录的变量包括主要关注点、是否进行头颈部 CTA 检查，如果进行了检查，则报告是否记录了非例行结果沟通。确定了导致头颈部 CTA 检查数量最多的前 50 个主要关注点。计算了头颈部 CTA 检查的频率和非例行结果沟通的频率。手动审查了记录非例行沟通的报告子集。在 236476 名患者（平均年龄 49.8±20.5[SD]岁；110952 名男性，125521 名女性，3 名未知性别）的 708145 次 ED 就诊中，有 2.5%（17903 次）行头颈部 CTA 检查。头颈部 CTA 检查用于 833 个不同的主要关注点。17903 次检查中有 17.6%（3155 次）记录了非例行结果沟通。在与检查数量最多的前 50 个主要关注点相关的 50 个主要关注点中，行头颈部 CTA 检查的频率从不足 0.5%（5 个关注点）到 55.2%（中风代码）不等，非例行沟通的频率从 5.6%（短暂性脑缺血发作）到 67.5%（无反应）不等。不属于前 50 个最常见关注点的主要关注点占检查的 50.0%（8956/17903）；这些关注点的非例行沟通总体频率为 4.8%（429/8956）。对 3155 次有非例行沟通的报告进行 11.1%（350 次）的手动审查表明，51.1%的报告中存在与适应证相关的急性发现，14.0%的报告中存在潜在的解释性发现，28.0%的报告中存在偶发发现，6.9%的报告中存在阴性结果的沟通。头颈部 CTA 用于 ED 就诊的各种主要关注点的比例为 2.5%。主要关注点之间的检查和非例行结果沟通的频率存在很大差异。与急性适应证相关的发现占非例行放射科医生沟通的一半。对头颈部 CTA 检查和非例行结果沟通模式的深入了解，可能有助于优化 ED 环境下的患者选择和放射科医生沟通。
