Appropriateness and imaging outcomes of ultrasound, CT, and MR in the emergency department: a retrospective analysis from an urban academic center.

Autor: Francisco MZ; Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, Brazil., Altmayer S; Stanford University, Palo Alto, CA, USA., Carlesso L; Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, Brazil., Zanon M; Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil., Eymael T; Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil., Lima JE; Stanford University, Palo Alto, CA, USA., Watte G; Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil., Hochhegger B; University of Florida, Gainesville, FL, USA. bhocheegger@ufl.edu.
Jazyk: angličtina
Zdroj: Emergency radiology [Emerg Radiol] 2024 Jun; Vol. 31 (3), pp. 367-372. Date of Electronic Publication: 2024 Apr 26.
DOI: 10.1007/s10140-024-02226-0
Abstrakt: Purpose: To evaluate the appropriateness and outcomes of ultrasound (US), computed tomography (CT), and magnetic resonance (MR) orders in the ED.
Methods: We retrospectively reviewed consecutive US, CT, and MR orders for adult ED patients at a tertiary care urban academic center from January to March 2019. The American College of Radiology Appropriateness Criteria (ACRAC) guidelines were primarily used to classify imaging orders as "appropriate" or "inappropriate". Two radiologists in consensus judged specific clinical scenarios that were unavailable in the ACRAC. Final imaging reports were compared with the initial clinical suspicion for imaging and categorized into "normal", "compatible with initial diagnosis", "alternative diagnosis", or "inconclusive". The sample was powered to show a prevalence of inappropriate orders of 30% with a margin of error of 5%.
Results: The rate of inappropriate orders was 59.4% for US, 29.1% for CT, and 33.3% for MR. The most commonly imaged systems for each modality were neuro (130/330) and gastrointestinal (95/330) for CT, genitourinary (132/330) and gastrointestinal (121/330) for US, neuro (273/330) and gastrointestinal (37/330) for MR. Compared to inappropriately ordered tests, the final reports of appropriate orders were nearly three times more likely to demonstrate findings compatible with the initial diagnosis for all modalities: US (45.5 vs. 14.3%, p < 0.001), CT (46.6 vs. 14.6%, p < 0.001), and MR (56.3 vs. 21.8%, p < 0.001). Inappropriate orders were more likely to show no abnormalities compared to appropriate orders: US (65.8 vs. 38.8%, p < 0.001), CT (62.5 vs. 34.2%, p < 0.001), and MR (61.8 vs. 38.7%, p < 0.001).
Conclusion: The prevalence of inappropriate imaging orders in the ED was 59.4% for US, 29.1% for CT, and 33.3% for MR. Appropriately ordered imaging was three times more likely to yield findings compatible with the initial diagnosis across all modalities.
(© 2024. The Author(s), under exclusive licence to American Society of Emergency Radiology (ASER).)
Databáze: MEDLINE
Externí odkaz: