Shock/Sepsis/Trauma/Critical CareUse of emergency department imaging in patients with minor trauma
Introduction
Over the past decade, there has been a dramatic rise in the use of imaging, specifically computed tomography (CT) in emergency departments in the United States [1], [2]. Imaging plays an important role in the diagnosis and treatment of injured patients. Current evidence suggests that early use of whole-body CT scanning may decrease mortality, reduce time spent in the emergency department, lead to more accurate diagnoses, and result in faster diagnosis in patients presenting with major trauma [3], [4], [5], [6], [7]. However, few publications have assessed the benefits of imaging for patients with minor trauma, especially for advanced imaging such as CT. This is important given the increased radiation exposure and associated cancer susceptibility, as well as high costs [8], [9], [10], [11], [12], [13].
Recent awareness of these issues has resulted in campaigns directed at reducing potential overuse of imaging studies [14], [15], [16]. And although numerous clinical decision making tools have been created to guide judicious ordering of CT imaging, studies indicate a lack of adherence to these prediction rules. [17], [18], [19], [20].
Identifying the prevalence and trend in utilization in patients with minor or no injuries is important, and no prior studies have fully evaluated these patients except studies focusing on minor head injuries [21]. The purpose of our study was to evaluate the frequency of CT imaging for adults with minor trauma presenting to the ED who ultimately did not require admission. We hypothesized that the utilization of imaging has increased even for patients with minor trauma.
Section snippets
Data sources
This retrospective review used nonpublic data from the California Office of Statewide Health Planning and Development (OSHPD) Emergency Department and Ambulatory Surgery Data (EDD) from 2005–2013. The OSHPD EDD contains all outpatient discharges from emergency department (ED) patient encounters in California and includes demographic, clinical, payer, and facility information [22]. More detailed information regarding data reporting and requirements is available at the California Emergency
Results
We identified a total of 8,535,831 patients with both ECODE diagnosis of trauma and ISS <9 who were seen in California emergency rooms and were subsequently discharged. Of these, 502,418 (5.9%) received at least one CT study during their ED visit (Table 1).
Patients who received a CT scan were different from those who did not. Patients aged >45 y and those aged 18–24 y were more likely to receive a CT as compared to those 25–34 y and 35–44 y (Table 1). On average, patients who received a CT scan
Discussion
Our results demonstrate that there has been an annual increase in the rate of CT utilization in the emergency department (ED) for patients presenting with minor injuries, rising from 3.51% in 2005 to 7.17% in 2013. Even after adjusted analysis of independent predictors of increased CT utilization, increasing year was still found to be associated with higher rates of CT, with year 2013 having 1.97-fold increase in CT utilization as compared to year 2005.
Prior studies have already identified the
Conclusion
In conclusion, there has been a growth of CT utilization from 2005 to 2013 for adult patients presenting with minor trauma to the ED. We identified that a significant proportion of these patients receiving CT studies were aged 18–24 years, those at greatest risk for radiation. Furthermore, we identified that trauma center designation was associated with higher CT use. Further work should assess whether this increase in imaging is leading to better patient outcomes and influencing treatment
Acknowledgment
We are grateful to Feng Lin, MS (University of California, San Francisco) for her assistance with data analysis and compensated for her contribution.
Author contributions: All authors participated in the study concept and design. G.T. and R.H. were involved in the data collection, analysis and interpretation of data. G.T. drafted the article. K.S. and R.H. did the critical revising of the article. All authors read and approved the final version of the article.
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Risk of delayed intracranial haemorrhage after an initial negative CT in patients on DOACs with mild traumatic brain injury
2022, American Journal of Emergency MedicineCitation Excerpt :In the study by Mourad et al., one of the two patients with delayed ICH presented with an altered GCS on arrival and the Injury Severity Score (ISS) value on admission seemed to suggest an increased risk of bleeding after a negative first CT [10]. However, the ISS value used in major trauma appears to be more complicated in the assessment of minor trauma as it requires an extensive and not immediate diagnostic assessment [25]. Concussion, in the present study was found to be associated with the presence of delayed ICH, is widely reported to be a risk condition for the traumatic brain injury patient.
Emergency and critical care applications for contrast-enhanced ultrasound
2018, American Journal of Emergency MedicinePoint-of-Care Ultrasound in Established Settings
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