Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322.
School of Economics, Georgia Institute of Technology, Atlanta, GA.
AJR Am J Roentgenol. 2023 Feb;220(2):265-271. doi: 10.2214/AJR.22.27991. Epub 2022 Aug 24.
Increases in the use of CT to evaluate patients presenting with trauma have raised concern about inappropriate imaging. The evolving utilization of CT for trauma evaluation may be impacted by injury severity. The purpose of this study was to explore patterns in utilization of chest and abdominopelvic CT among trauma-related emergency department (ED) visits across the United States. This retrospective study was conducted with national commercial claims information extracted from the MarketScan Commercial Database. Trauma-related ED encounters were identified from the 2011-2018 MarketScan database files and classified by injury severity score (minor, intermediate, and major injuries) on the basis of International Classification of Diseases codes. ED encounters were also assessed for chest CT, abdominopelvic CT, and single-encounter chest and abdominopelvic CT examinations. Utilization per 1000 trauma-related ED encounters was determined. Multivariable Poisson regression models were used to determine incidence rate ratios (IRRs) as a measure of temporal changes in utilization. From 2011 to 2018, 8,369,092 trauma-related ED encounters were identified (5,685,295 for minor, 2,624,944 for intermediate, and 58,853 for major injuries). Utilization of chest CT per 1000 trauma-related ED encounters increased from 4.9 to 13.5 examinations (adjusted IRR, 1.15 per year; minor injuries, from 2.2 to 7.7 [adjusted IRR, 1.17]; intermediate injuries, from 8.5 to 21.5 [adjusted IRR, 1.16]; major injuries, from 117.8 to 200.1 [adjusted IRR, 1.08]). Utilization of abdominopelvic CT per 1000 trauma-related ED encounters increased from 7.5 to 16.4 (adjusted IRR, 1.12; minor injuries, 4.8 to 12.2 [adjusted IRR, 1.13]; intermediate injuries, 10.6 to 21.7 [adjusted IRR, 1.13]; major injuries, 134.8 to 192.6 [adjusted IRR, 1.07]). Utilization of single-encounter chest and abdominopelvic CT per 1000 trauma-related ED encounters increased from 3.4 to 8.9 [adjusted IRR, 1.16; minor injuries, 1.1 to 4.6 [adjusted IRR, 1.18]; intermediate injuries, 6.4 to 16.4 [adjusted IRR, 1.16]; major injuries, 99.6 to 179.9 [adjusted IRR, 1.08]). National utilization of chest and abdominopelvic CT for trauma-related ED encounters increased among commercially insured patients from 2011 to 2018, particularly for single-encounter chest and abdominopelvic CT examinations and for minor injuries. Given concerns about increased cost and detection of incidental findings, further investigation is warranted to explore the potential benefit of single-encounter chest and abdominopelvic CT examinations of patients with minor injuries and to develop strategies for optimizing appropriateness of imaging orders.
在美国，由于创伤患者中 CT 检查的使用增加，人们对不适当的影像学检查表示担忧。CT 在创伤评估中的应用可能会受到损伤严重程度的影响。本研究旨在探讨美国创伤相关急诊科（ED）就诊患者中胸部和腹部盆腔 CT 的使用模式。本回顾性研究利用从 MarketScan 商业数据库中提取的全国商业索赔信息进行。创伤相关 ED 就诊病例从 2011-2018 年 MarketScan 数据库文件中确定，并根据国际疾病分类（ICD）代码将损伤严重程度评分（轻度、中度和重度损伤）进行分类。还评估了 ED 就诊的胸部 CT、腹部盆腔 CT 和单次胸部和腹部盆腔 CT 检查。确定每 1000 例创伤相关 ED 就诊的利用情况。使用多变量泊松回归模型确定时间变化的利用情况的发病率比值比（IRR）。2011 年至 2018 年期间，共确定了 836.9092 例创伤相关 ED 就诊病例（轻度 568.5295 例，中度 2624.944 例，重度 58.853 例）。胸部 CT 每 1000 例创伤相关 ED 就诊的利用情况从 4.9 次增加到 13.5 次（调整后的 IRR，每年增加 1.15；轻度损伤，从 2.2 次增加到 7.7 次[调整后的 IRR，1.17]；中度损伤，从 8.5 次增加到 21.5 次[调整后的 IRR，1.16]；重度损伤，从 117.8 次增加到 200.1 次[调整后的 IRR，1.08]）。腹部盆腔 CT 每 1000 例创伤相关 ED 就诊的利用情况从 7.5 次增加到 16.4 次（调整后的 IRR，1.12；轻度损伤，从 4.8 次增加到 12.2 次[调整后的 IRR，1.13]；中度损伤，从 10.6 次增加到 21.7 次[调整后的 IRR，1.13]；重度损伤，从 134.8 次增加到 192.6 次[调整后的 IRR，1.07]）。每 1000 例创伤相关 ED 就诊的单次胸部和腹部盆腔 CT 利用情况从 3.4 次增加到 8.9 次（调整后的 IRR，1.16；轻度损伤，从 1.1 次增加到 4.6 次[调整后的 IRR，1.18]；中度损伤，从 6.4 次增加到 16.4 次[调整后的 IRR，1.16]；重度损伤，从 99.6 次增加到 179.9 次[调整后的 IRR，1.08]）。2011 年至 2018 年期间，商业保险患者中创伤相关 ED 就诊的胸部和腹部盆腔 CT 全国利用率增加，尤其是单次胸部和腹部盆腔 CT 检查和轻度损伤。鉴于对增加成本和偶然发现的担忧，需要进一步调查，以探讨对轻度损伤患者进行单次胸部和腹部盆腔 CT 检查的潜在益处，并制定优化影像学检查的策略。
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