Powell Adam C, Long James W, Deshmukh Uday U, Simmons Jeffrey D
HealthHelp, Houston, TX, United States.
Humana Inc, Louisville, KY, United States.
JMIR Form Res. 2022 Jun 30;6(6):e32892. doi: 10.2196/32892.
Although computed tomography (CT) studies on machines with more slices have reported higher positive and negative predictive values, the impact of using low-slice (16-slice) CT machines on downstream testing has not been well studied. In community outpatient settings, low-slice CT machines remain in use, although many hospitals have adopted higher-slice machines.
This study examines the association between the use of low-slice CT machines and downstream invasive testing in the context of the CT angiography of the neck.
Included health insurance claims pertained to adults with commercial or Medicare Advantage health plans who underwent the CT angiography of the neck. Site certification data were used to assign counts of slices to claims. Claims that were made in the 60 days after CT were examined for cervicocerebral angiography. The association between the number of slices and cervicocerebral angiography was evaluated by using a chi-square test and multivariate logistic regression.
Claims for 16-slice CT had a 5.1% (33/641) downstream cervicocerebral angiography rate, while claims for 64-slice CT had a 3.1% (35/1125) rate, and a significant difference (P=.03) was observed. An analysis that was adjusted for patient demographics also found a significant relationship (odds ratio 1.64, 95% CI 1.00-2.69; P=.047).
The use of low-slice CT machines in the community may impact the quality of care and result in more downstream testing.
尽管关于多层螺旋CT扫描仪的计算机断层扫描（CT）研究报告称其具有更高的阳性和阴性预测价值，但使用低层（16层）CT扫描仪对下游检测的影响尚未得到充分研究。在社区门诊环境中，尽管许多医院已采用高层CT扫描仪，但低层CT扫描仪仍在使用。
本研究探讨在颈部CT血管造影的背景下，使用低层CT扫描仪与下游侵入性检测之间的关联。
纳入的医疗保险理赔数据涉及参加商业保险或医疗保险优势计划的成年人，这些人接受了颈部CT血管造影检查。利用机构认证数据为理赔数据分配层数。对CT检查后60天内进行的脑颈血管造影检查的理赔数据进行分析。采用卡方检验和多因素逻辑回归分析评估层数与脑颈血管造影之间的关联。
16层CT检查后的理赔数据中，下游脑颈血管造影率为5.1%（33/641），而64层CT检查后的理赔数据中，该率为3.1%（35/1125），差异有统计学意义（P = 0.03）。对患者人口统计学特征进行校正后的分析也发现了显著相关性（比值比1.64，95%可信区间1.00-2.69；P = 0.047）。
在社区使用低层CT扫描仪可能会影响医疗质量，并导致更多的下游检测。
