Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, 300, Taiwan.
Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, 100, Taiwan.
BMC Emerg Med. 2024 May 20;24(1):87. doi: 10.1186/s12873-024-01003-z.
Computed tomography (CT) is frequently performed in the patients who admitted to the emergency department (ED), discharged but returned to ED within 72 h. It is unknown whether the main complaints of patients assist physicians to use CT effectively. This study aimed to find the association between chief complaints and the CT results.
This three-year retrospective cohort study was conducted in the ED of a tertiary medical center. Adult patients who returned to the ED after the index visit were included from 2019 to 2021. Demographics, pre-existing diseases, chief complaints, and CT region were recorded by independent ED physicians. A logistic regression model with an odds ratio (OR) and 95% confidence interval (CI) was used to determine the relationship between chief complaints and positive CT results.
In total, 7,699 patients revisited ED after the index visit; 1,202 (15.6%) received CT. The top chief complaints in patients who received CT were abdominal pain, dizziness, and muscle weakness. Patients with abdominal pain or gastrointestinal symptoms had a significantly higher rate of positive abdominopelvic CT than those without it (OR 2.83, 95% CI 1.98-4.05, p < 0.001), while the central nervous system and cardiopulmonary chief complaints were not associated (or negatively associated) with new positive CT findings.
Chief complaints of patients on revisit to the ED are associated with different yields of new findings when CT scans of the chest, abdomen and head are performed. Physicians should consider these differential likelihoods of new positive findings based on these data.
在因急症就诊并出院但在 72 小时内返回急诊部（ED）的患者中，经常进行计算机断层扫描（CT）。目前尚不清楚患者的主要主诉是否有助于医生有效地使用 CT。本研究旨在探讨主要主诉与 CT 结果之间的关系。
这是一项为期三年的回顾性队列研究，在一家三级医学中心的 ED 进行。纳入了 2019 年至 2021 年期间因就诊后返回 ED 的成年患者。ED 医生独立记录了患者的人口统计学、既往疾病、主要主诉和 CT 部位。使用比值比（OR）和 95%置信区间（CI）的逻辑回归模型来确定主要主诉与阳性 CT 结果之间的关系。
共有 7699 名患者在就诊后返回 ED；1202 名（15.6%）接受了 CT。接受 CT 的患者中最常见的主诉是腹痛、头晕和肌肉无力。有腹痛或胃肠道症状的患者，其阳性腹部盆腔 CT 率明显高于无腹痛或胃肠道症状的患者（OR 2.83，95%CI 1.98-4.05，p<0.001），而中枢神经系统和心肺主诉与新的阳性 CT 发现无关（或负相关）。
在对 ED 进行复诊时，患者的主诉与进行胸部、腹部和头部 CT 扫描时新发现的阳性结果的发生率有关。医生应根据这些数据考虑这些新的阳性发现的不同可能性。
