Use of advanced radiology during visits to US emergency departments for injury-related conditions, 1998-2007.

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  • Author(s): Korley FK;Korley FK; Pham JC; Kirsch TD
  • Source:
    JAMA [JAMA] 2010 Oct 06; Vol. 304 (13), pp. 1465-71.
  • Publication Type:
    Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't
  • Language:
    English
  • Additional Information
    • Source:
      Publisher: American Medical Association Country of Publication: United States NLM ID: 7501160 Publication Model: Print Cited Medium: Internet ISSN: 1538-3598 (Electronic) Linking ISSN: 00987484 NLM ISO Abbreviation: JAMA Subsets: MEDLINE
    • Publication Information:
      Original Publication: Chicago : American Medical Association, 1960-
    • Subject Terms:
      Emergency Service, Hospital/*statistics & numerical data ; Magnetic Resonance Imaging/*statistics & numerical data ; Tomography, X-Ray Computed/*statistics & numerical data ; Wounds and Injuries/*diagnostic imaging ; Wounds and Injuries/*epidemiology; Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Critical Illness/epidemiology ; Cross-Sectional Studies ; Decision Support Systems, Clinical ; Female ; Health Care Costs ; Humans ; Infant ; Intensive Care Units/statistics & numerical data ; Magnetic Resonance Imaging/economics ; Male ; Middle Aged ; Patient Admission/statistics & numerical data ; Prevalence ; Retrospective Studies ; Tomography, X-Ray Computed/economics ; United States/epidemiology ; Wounds and Injuries/pathology ; Young Adult
    • Abstract:
      Context: Excessive use of medical imaging increases health care costs and exposure to ionizing radiation (a potential carcinogen) without yielding significant benefits to all patients.
      Objective: To determine whether there has been a change in the prevalence of emergency department visits for injury-related conditions for which computed tomography (CT) or magnetic resonance imaging (MRI) was obtained and whether there has been a change in the diagnosis of life-threatening conditions and patient disposition.
      Design, Setting, and Participants: Retrospective cross-sectional analysis of emergency department visits using data from the National Hospital Ambulatory Medical Care Survey (1998-2007). Sampled visits were weighted to produce estimates for the United States.
      Main Outcomes Measures: Proportion of visits for injury-related conditions during which a CT or MRI was obtained, a life-threatening condition was diagnosed (eg, cervical spine fracture, skull fracture, intracranial bleeding, liver and spleen laceration), and which resulted in hospital and intensive care unit admission.
      Results: The prevalence of CT or MRI use during emergency department visits for injury-related conditions increased from 6% (95% confidence interval [CI], 5%-7%) (257 of 5237 visits) in 1998 to 15% (95% CI, 14%-17%) (981 of 6567 visits) in 2007 (P < .001 for trend). There was a small increase in the prevalence of life-threatening conditions (1.7% [95% CI, 1.2%-2.2%; 89 of 5237 visits] in 1998 and 2.0% [95% CI, 1.6%-2.5%; 142 of 6567 visits] in 2007; P=.04 for trend) [corrected].There was no change in prevalence of visits during which patients were either admitted to the hospital (5.9% [95% CI, 4.9%-6.9%] in 1998 and 5.5% [95% CI, 4.7%-6.5%] in 2007; P = .50 for trend) or to an intensive care unit (0.62% [95% CI, 0.40%-1.00%] in 1998 and 0.80% [95% CI, 0.53%-1.21%] in 2007; P = .14 for trend). Visits during which CT or MRI was obtained lasted 126 minutes (95% CI, 123-131 minutes) longer than those for which CT or MRI was not obtained.
      Conclusion: From 1998 to 2007, the prevalence of CT or MRI use during emergency department visits for injury-related conditions increased significantly, without an equal increase in the prevalence of life-threatening conditions.
    • Comments:
      Erratum in: JAMA. 2010 Nov 3;304(17):1901.
      Comment in: JAMA. 2011 Jan 12;305(2):148-9; author reply 149. (PMID: 21224454)
    • Grant Information:
      KL2 RR025006 United States RR NCRR NIH HHS; 5KL2RR025006 United States RR NCRR NIH HHS
    • Publication Date:
      Date Created: 20101007 Date Completed: 20101008 Latest Revision: 20220317
    • Publication Date:
      20240829
    • Accession Number:
      10.1001/jama.2010.1408
    • Accession Number:
      20924012