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Yi X, Yao L, Zhao P, Yuan X, Wang Z. Three-dimensional assessment of pharyngeal volume and cross-sectional area in Chinese infants and preschool children. Int J Pediatr Otorhinolaryngol 2020; 136:110253. [PMID: 32797809 DOI: 10.1016/j.ijporl.2020.110253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/26/2020] [Accepted: 07/04/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The cross-sectional area (CSA) and the volume of the pharyngeal airway normative reference data aren't established, although they are closely associated with the pathogenesis of obstructive sleep apnea syndrome (OSAS) in infants and preschool children. Our objective is to measure the cross-sectional area (CSA) and volume of pharyngeal airway subregions and investigate the effects of age and sex in infants and preschool children using computerized tomography (CT). METHODS After applying strict inclusion criteria, 57 infants and preschool children (27 females, 30 males) aged from 1 day to 72 months who underwent maxillofacial CT scans due to trauma were selected. The sample was stratified into three age groups (1 day-24 months, 25-48 months, and 49-72 months). The CSA and the volume of the naso-, palato-, glosso-, and laryngopharyngeal airway were calculated using a 3-dimensional image processing software. Linear regression analysis was performed to express the effect of age, height, and weight. One-way analysis of covariance with height as a covariate was used to analyze the statistical significance of the difference between males and females within each age group. RESULTS The CSA and volume of all pharyngeal airway subregions increased with age, height, and weight (P < 0.05) in children under 6 years old. Multiple linear regression analysis showed an age effect, identified in all measurements (P < 0.001), whereas no height or weight effect were found. There were no differences in any measurements between males and females within each age group. CONCLUSION The normative reference data of CSA and volume of pharyngeal airway subregions were established after applying strict inclusion and exclusion criteria in infants and preschool children. Results may be useful in screening and assist in the timely diagnosis and management of pediatric OSAS.
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Affiliation(s)
- Xiaoli Yi
- Department of Radiology, The Affiliated Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Linyin Yao
- Department of Otolaryngology Head and Neck Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Pengfei Zhao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xinyu Yuan
- Department of Radiology, The Affiliated Children's Hospital, Capital Institute of Pediatrics, Beijing, China.
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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Reduction in Head Computed Tomography Ordering in Pediatric Emergency Patients: Effect of National Publication and Local Availability of Urgent Neurology Appointments. Pediatr Emerg Care 2019; 35:199-203. [PMID: 30747787 DOI: 10.1097/pec.0000000000001757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the effect of the Pediatric Emergency Care Applied Research Network (PECARN) blunt head trauma guidelines and implementation of urgent neurology follow-up (UNF) appointments on an observed decline in head computed tomography (CT) use for pediatric emergency department (PED) patients presenting with headache, seizure, and trauma. METHODS Patients ages 0 to 18 years presenting to and discharged from an urban tertiary care PED with chief complaint of trauma, headache, and seizure between 2007 and 2013 were retrospectively included. The total number of head CTs obtained in the trauma, headache, and seizure groups was compared before and after the publication of the PECARN guidelines in 2009 and the implementation of urgent UNF within a week from PED discharge in 2011, respectively. RESULTS Between 2007 and 2013, 24,434 encounters were identified with 2762 head CTs performed. Analysis demonstrated a decline in pediatric head CTs for trauma (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.8-2.2) after the publication of the PECARN study on blunt head trauma, for headache (OR, 1.4; 95% CI, 1.1-1.8) and seizure (OR, 1.9; 95% CI, 1.4-2.6) with UNF. However, cross comparison (headache and seizure with PECARN and trauma with UNF) also demonstrated similar significant declines. CONCLUSIONS The decline in head CTs observed at our institution demonstrated a strong linear relationship, yet cannot be solely attributed to the PECARN blunt head trauma study or the implementation of UNF.
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Abstract
BACKGROUND Little is known regarding the effect of different emergency department (ED) practice models on computed tomography (CT) and ultrasound (US) utilization for suspected appendicitis in the ED and through the potential inpatient hospital stay. OBJECTIVES Examination rates of CT and US for suspected appendicitis at 2 different pediatric EDs (PEDs) through hospital admission: an academic affiliated tertiary PED (site A) compared with a private practice tertiary care PED (site B). METHODS All visits with the ICD-9 (International Classification of Diseases, Ninth Revision) chief complaint of abdominal pain were retrospectively examined from May 1, 2009, to February 21, 2012. Suspected appendicitis visits were defined as any visit with the chief complaint of abdominal pain where a complete blood cell count was obtained. Abdominal CT and US in the PED and during hospital admission were compared across the 2 sites. Return visits within 72 hours were evaluated for any missed appendicitis. RESULTS Overall appendicitis rates were similar at both sites: site A, 4.7%; site B, 4.0%. The odds of having a CT scan performed during visits to the PED for abdominal pain were significantly higher at site B (odds ratio [OR], 3.19; 95% confidence interval [95% CI], 2.74-3.71), whereas the odds of having an US at site B were the opposite (OR, 0.34; 95% CI, 0.28-0.40). When evaluating only the admitted visits, the odds of having a CT were also greater at site B (OR, 2.32; 95% CI, 1.86-2.94) and having an US were less (OR, 0.57; 95% CI, 0.44-0.73). CONCLUSIONS In this study of 2 PEDs with differing practice models, we identified a dramatic difference in imaging utilization among patients with suspected appendicitis.
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Power SP, Moloney F, Twomey M, James K, O’Connor OJ, Maher MM. Computed tomography and patient risk: Facts, perceptions and uncertainties. World J Radiol 2016; 8:902-915. [PMID: 28070242 PMCID: PMC5183924 DOI: 10.4329/wjr.v8.i12.902] [Citation(s) in RCA: 161] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/29/2016] [Accepted: 10/24/2016] [Indexed: 02/06/2023] Open
Abstract
Since its introduction in the 1970s, computed tomography (CT) has revolutionized diagnostic decision-making. One of the major concerns associated with the widespread use of CT is the associated increased radiation exposure incurred by patients. The link between ionizing radiation and the subsequent development of neoplasia has been largely based on extrapolating data from studies of survivors of the atomic bombs dropped in Japan in 1945 and on assessments of the increased relative risk of neoplasia in those occupationally exposed to radiation within the nuclear industry. However, the association between exposure to low-dose radiation from diagnostic imaging examinations and oncogenesis remains unclear. With improved technology, significant advances have already been achieved with regards to radiation dose reduction. There are several dose optimization strategies available that may be readily employed including omitting unnecessary images at the ends of acquired series, minimizing the number of phases acquired, and the use of automated exposure control as opposed to fixed tube current techniques. In addition, new image reconstruction techniques that reduce radiation dose have been developed in recent years with promising results. These techniques use iterative reconstruction algorithms to attain diagnostic quality images with reduced image noise at lower radiation doses.
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Langarizadeh M, Moghbeli F. Applying Naive Bayesian Networks to Disease Prediction: a Systematic Review. Acta Inform Med 2016; 24:364-369. [PMID: 28077895 PMCID: PMC5203736 DOI: 10.5455/aim.2016.24.364-369] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 10/11/2016] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Naive Bayesian networks (NBNs) are one of the most effective and simplest Bayesian networks for prediction. OBJECTIVE This paper aims to review published evidence about the application of NBNs in predicting disease and it tries to show NBNs as the fundamental algorithm for the best performance in comparison with other algorithms. METHODS PubMed was electronically checked for articles published between 2005 and 2015. For characterizing eligible articles, a comprehensive electronic searching method was conducted. Inclusion criteria were determined based on NBN and its effects on disease prediction. A total of 99 articles were found. After excluding the duplicates (n= 5), the titles and abstracts of 94 articles were skimmed according to the inclusion criteria. Finally, 38 articles remained. They were reviewed in full text and 15 articles were excluded. Eventually, 23 articles were selected which met our eligibility criteria and were included in this study. RESULT In this article, the use of NBN in predicting diseases was described. Finally, the results were reported in terms of Accuracy, Sensitivity, Specificity and Area under ROC curve (AUC). The last column in Table 2 shows the differences between NBNs and other algorithms. DISCUSSION This systematic review (23 studies, 53,725 patients) indicates that predicting diseases based on a NBN had the best performance in most diseases in comparison with the other algorithms. Finally in most cases NBN works better than other algorithms based on the reported accuracy. CONCLUSION The method, termed NBNs is proposed and can efficiently construct a prediction model for disease.
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Affiliation(s)
- Mostafa Langarizadeh
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Fateme Moghbeli
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Portelli JL, McNulty JP, Bezzina P, Rainford L. Frequency of paediatric medical imaging examinations performed at a European teaching hospital over a 7-year period. Eur Radiol 2016; 26:4221-4230. [DOI: 10.1007/s00330-016-4305-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 02/18/2016] [Accepted: 02/23/2016] [Indexed: 11/24/2022]
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Merck LH, Ward LA, Applegate KE, Choo E, Lowery-North DW, Heilpern KL. Written Informed Consent for Computed Tomography of the Abdomen/Pelvis is Associated with Decreased CT Utilization in Low-Risk Emergency Department Patients. West J Emerg Med 2015; 16:1014-24. [PMID: 26759646 PMCID: PMC4703183 DOI: 10.5811/westjem.2015.9.27612] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/21/2015] [Accepted: 09/27/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The increasing rate of patient exposure to radiation from computerized tomography (CT) raises questions about appropriateness of utilization. There is no current standard to employ informed consent for CT (ICCT). Our study assessed the relationship between informed consent and CT utilization in emergency department (ED) patients. METHODS An observational multiphase before-after cohort study was completed from 4/2010-5/2011. We assessed CT utilization before and after (Time I/Time II) the implementation of an informed consent protocol. Adult patients were included if they presented with symptoms of abdominal/pelvic pathology or completed ED CT. We excluded patients with pregnancy, trauma, or altered mental status. Data on history, exam, diagnostics, and disposition were collected via standard abstraction tool. We generated a multivariate logistic model via stepwise regression, to assess CT utilization across risk groups. Logistic models, stratified by risk, were generated to include study phase and a propensity score that controlled for potential confounders of CT utilization. RESULTS 7,684 patients met inclusion criteria. In PHASE 2, there was a 24% (95% CI [10-36%]) reduction in CT utilization in the low-risk patient group (p<0.002). ICCT did not affect CT utilization in the high-risk group (p=0.16). In low-risk patients, the propensity score was significant (p<0.001). There were no adverse events reported during the study period. CONCLUSION The implementation of ICCT was associated with reduced CT utilization in low-risk ED patients. ICCT has the potential to increase informed, shared decision making with patients, as well as to reduce the risks and cost associated with CT.
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Affiliation(s)
- Lisa H. Merck
- The Warren Alpert Medical School of Brown University, Department of Emergency Medicine and Diagnostic Imaging, Providence, Rhode Island
| | - Laura A. Ward
- Rollins School of Public Health, Department of Biostatistics, Emory University, Atlanta, Georgia
| | - Kimberly E. Applegate
- Emory University School of Medicine, Department of Radiology and Imaging Sciences, Atlanta, Georgia
| | - Esther Choo
- The Warren Alpert Medical School of Brown University, Department of Emergency Medicine, Providence, Rhode Island
| | - Douglas W. Lowery-North
- Emory University School of Medicine and Grady Memorial Hospital, Department of Emergency Medicine, Atlanta, Georgia
| | - Katherine L. Heilpern
- Emory University School of Medicine and Grady Memorial Hospital, Department of Emergency Medicine, Atlanta, Georgia
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Trends in CT Utilization for Pediatric Fall Patients in US Emergency Departments. Acad Radiol 2015; 22:898-903. [PMID: 25957501 DOI: 10.1016/j.acra.2015.02.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 01/27/2015] [Accepted: 02/18/2015] [Indexed: 11/22/2022]
Abstract
RATIONALE AND OBJECTIVES Falls are a common cause of emergency department (ED) visits in the United States. We evaluated trends in computed tomography (CT) utilization for pediatric fall victims in the United States from 2001 to 2010. MATERIALS AND METHODS Using the National Hospital Ambulatory Medical Care Survey from 2001 to 2010, we identified all visits of pediatric (aged <18 years) patients presenting to EDs after falls. This database surveys approximately 500 EDs per year for 4 weeks providing national estimates on ED resource utilization and outcomes. We studied trends in CT utilization and proportion of visits with life-threatening conditions after falls. We also studied the association between CT utilization rates and demographic characteristics and admission status. RESULTS A total of 9763 unweighted observations for a total of 32,432,686 pediatric fall patients were seen in US EDs from 2001 to 2010. The proportion of pediatric fall patients receiving CT increased from 5.3% in 2001 to a peak of 16.6% in 2009 and decreased to 11.3% in 2010, whereas the proportion of pediatric fall patients with life-threatening conditions fluctuated between 1.2% and 3.3% during this period. In multivariate logistic regression analysis, each increasing year was independently associated with CT utilization (odds ratio [OR], 1.15; 95% confidence interval [CI], 1.14-1.16). Patients aged 0-1 years had higher odds of CT utilization than patients aged 13-17 years (OR, 2.27; 95% CI, 2.26-2.27). CONCLUSIONS There was a twofold increase in CT utilization among pediatric fall visits from 2001 to 2010. When controlling for demographic and clinical variables, increasing year was independently associated with CT utilization. These findings suggest that CT may be overutilized among pediatric fall patients.
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Kim Y, Kang G, Moon SB. Increasing utilization of abdominal CT in the Emergency Department of a secondary care center: does it produce better outcomes in caring for pediatric surgical patients? Ann Surg Treat Res 2014; 87:239-44. [PMID: 25368849 PMCID: PMC4217253 DOI: 10.4174/astr.2014.87.5.239] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 05/21/2014] [Accepted: 06/09/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The use of abdominal computed tomography (ACT) utilization is increasing to a remarkable extent in the pediatric Emergency Department (ED), but the clinical benefit of increased use of ACT for pediatric surgical patients remains uncertain. METHODS A retrospective review was conducted to investigate if, for patients who had visited pediatric ED during the last 5 years, increasing utilization of ACT would increase the detection rate of acute appendicitis, increase the detection rate of surgical conditions other than appendicitis, and decrease the hospital admission rate for surgical conditions. RESULTS During the study period, there were 37,918 ED visits; of these, 3,274 (8.6%) were for abdominal pain, 844 (2.2%) had ACT performed. The annual proportional increase of the ACT was statistically significant (1.56% to 2.46%, P = 0.00), but the detection rate of acute appendicitis (3.3% to 5.1%) or other surgical conditions (1.7% to 2.8%) showed no statistically significant changes. Hospital admission rates (5.6% to 6.8%) also showed no significant changes during the study period. CONCLUSION Increasing utilization of ACT does not lead to the improved outcomes in caring for pediatric surgical patients visiting the pediatric ED. Careful evaluation for the indication for ACT is needed in the pediatric ED.
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Affiliation(s)
- Younglim Kim
- Department of Surgery, Kangwon National University Hospital, Chuncheon, Korea
| | - Gu Kang
- Department of Pathology, Kangwon National University Hospital, Chuncheon, Korea. ; Kangwon National University School of Medicine, Chuncheon, Korea
| | - Suk-Bae Moon
- Department of Surgery, Kangwon National University Hospital, Chuncheon, Korea. ; Kangwon National University School of Medicine, Chuncheon, Korea
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Abstract
PURPOSE OF REVIEW Our objective is to highlight recent literature investigating low-radiation diagnostic strategies in the evaluation of pediatric trauma. RECENT FINDINGS In the area of minor head injury, research has focused on implementation of validated clinical decision rules into practice to reduce unnecessary computed tomography scans. Clinical observation may also serve as an adjunct to initial assessment and a potential substitute for computed tomography imaging. Subgroups of children with special needs or severe injury mechanisms may also be safely characterized by the clinical decision rule and spared radiation exposure. Physical examination techniques may be useful in diagnosing mandibular fractures. In addition, evidence suggests that plain radiography for evaluation of blunt thoracic trauma may be sufficient in many cases, and computed tomography could be reserved for those with abnormal radiographs, high-risk mechanisms, or abnormal physical findings. Clinical decision rules are able to predict intra-abdominal injury with high sensitivity. Data suggest that skeletal surveys may be modified to limit radiation exposure in the case of suspected nonaccidental trauma. SUMMARY More research is needed in development of pediatric-specific clinical decision rules and risk stratification and in testing low-radiation diagnostic modalities in the pediatric trauma population.
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Computed tomography utilization rates after the placement of a scanner in an emergency department: a single-center experience. Emerg Radiol 2014; 21:473-8. [DOI: 10.1007/s10140-014-1217-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 03/21/2014] [Indexed: 12/14/2022]
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Brunner CC, Stern SH, Minniti R, Parry MI, Skopec M, Chakrabarti K. CT head-scan dosimetry in an anthropomorphic phantom and associated measurement of ACR accreditation-phantom imaging metrics under clinically representative scan conditions. Med Phys 2013; 40:081917. [DOI: 10.1118/1.4815964] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Tepper B, Brice JH, Hobgood CD. Evaluation of Radiation Exposure to Pediatric Trauma Patients. J Emerg Med 2013; 44:646-52. [DOI: 10.1016/j.jemermed.2012.09.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 08/30/2012] [Accepted: 09/18/2012] [Indexed: 11/17/2022]
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Roudsari BS, Psoter KJ, Vavilala MS, Mack CD, Jarvik JG. CT use in hospitalized pediatric trauma patients: 15-year trends in a level I pediatric and adult trauma center. Radiology 2013; 267:479-86. [PMID: 23440320 DOI: 10.1148/radiol.13120865] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE To evaluate the 15-year trend in the use of computed tomography (CT) in hospitalized pediatric trauma patients admitted to Harborview Medical Center (HMC) from 1996 to 2010. MATERIALS AND METHODS This Health Insurance Portability and Accountability Act-compliant retrospective study was approved by the institutional review board. The requirement for informed consent was waived. The HMC trauma registry was linked to the billing department data, and patient and injury-related characteristics were extracted, in addition to type and frequency of CT procedures. Patients discharged from the emergency department and patients hospitalized for less than 24 hours were not included in this study. Patients were classified into three categories according to age: 0-14 years, 15-18 years, and 19-54 years (reference group). Multivariate negative binomial regression was used to compare CT usage among different age groups by adjusting for patient sex, race and/or ethnicity, insurance status, mechanism of injury, injury severity, final disposition (dead vs alive), and year of admission. The trend for CT use in children and teenagers was also evaluated. RESULTS A total of 64 425 trauma patients 0-54 years of age were admitted during the study period. Compared with CT usage in adults 19-54 years old, usage in children up to 15 years of age was significantly lower for spine (incidence rate ratio [IRR], 0.89; 95% confidence interval [CI]: 0.85, 0.92), maxillofacial (IRR, 0.89; 95% CI: 0.81, 0.97), and thoracic (IRR, 0.91; 95% CI: 0.84, 0.99) CT. Increased use of head CT was observed in children up to 15 years old (IRR, 1.09; 95% CI: 1.05, 1.13) and 15-18 years old (IRR, 1.08; 95% CI: 1.04, 1.13). From 2008 to 2010, usage rates in children up to 15 years old and 15-18 years old was relatively unchanged or slightly decreased for almost all CT types. CONCLUSION A decreasing or unchanged trend was observed in CT usage in hospitalized pediatric trauma patients in recent years. © RSNA, 2013.
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Affiliation(s)
- Bahman S Roudsari
- Department of Radiology, Comparative Effectiveness, Cost, and Outcomes Research Center, University of Washington, 325 Ninth Ave, Box 359960, Seattle, WA 98104, USA.
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Burden of alcohol-related injuries on radiology services at a level I trauma center. AJR Am J Roentgenol 2012; 199:W444-8. [PMID: 22997393 DOI: 10.2214/ajr.11.8435] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to evaluate the burden of alcohol-related injuries on a radiology department at a level 1 trauma center. MATERIALS AND METHODS We linked the trauma registry (2005-2009) of Harborview Medical Center to billing department data and extracted patient demographic and injury-related characteristics and the radiology services provided. Multivariate negative binomial analysis was used to evaluate the association between blood alcohol concentration (BAC) and CT and MRI utilization rates. RESULTS A total of 125,776 CT and 4681 MRI examinations were performed on 27,274 patients during the study period. Higher BAC was generally associated with higher utilization rates for all types of CT even after adjusting for potential confounding variables. Compared with patients with a BAC of 0, the greatest increases in utilization were observed in individuals with a BAC of 240 mg/dL or more for head CT (incidence rate ratio [IRR], 1.43; 95% CI, 1.32-1.54), cervical spine (IRR, 1.45; 95% CI, 1.32-1.58), and maxillofacial (IRR, 1.66; 95% CI, 1.42-1.95), with no increase observed for MRI. This association was more prominent in less severely injured patients with utilization rates for head CT (IRR, 1.83; 95% CI, 1.56-2.13), abdomen (IRR, 1.46; 95% CI, 1.32-1.63), and thorax (IRR, 1.57; 95% CI, 1.30-1.89) in individuals with a BAC of 240 mg/dL or more compared with those with a BAC of 0. CONCLUSION Higher BAC was associated with increased CT utilization for most body region-specific CT scans and was more strongly associated in patients with less severe injuries. Any guideline that could potentially decrease unnecessary imaging for patients with alcohol-involved injuries would represent a cost-saving strategy.
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Ma X, Singh A, Fay J, Boland G, Sahani DV. Comparison of Dual-Syringe and Syringeless Power Injectors in Outpatient MDCT Practice: Impact on the Operator's Performance, CT Workflow, and Operation Cost. J Am Coll Radiol 2012; 9:578-82. [DOI: 10.1016/j.jacr.2012.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 04/10/2012] [Indexed: 10/28/2022]
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Klement W, Wilk S, Michalowski W, Farion KJ, Osmond MH, Verter V. Predicting the need for CT imaging in children with minor head injury using an ensemble of Naive Bayes classifiers. Artif Intell Med 2012; 54:163-70. [DOI: 10.1016/j.artmed.2011.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Revised: 10/18/2011] [Accepted: 11/24/2011] [Indexed: 10/14/2022]
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Menoch MJA, Hirsh DA, Khan NS, Simon HK, Sturm JJ. Trends in computed tomography utilization in the pediatric emergency department. Pediatrics 2012; 129:e690-7. [PMID: 22331345 DOI: 10.1542/peds.2011-2548] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The purpose of this study was to determine the overall trend of computed tomography (CT) utilization in the pediatric emergency department (PED) from 2003 to 2010 and to determine trends categorized by common chief complaints. METHODS Electronic chart records at 2 tertiary care PEDs within a large pediatric health care system were reviewed from January 2003 through December 2010. The annual CT utilization rate, by anatomic location, was determined. Annual CT utilization rates were compared with alternative imaging trends for visits with chief complaints of head injury, seizure, and abdominal pain. Analysis was performed with linear regression. RESULTS There was no change in overall CT utilization from 2003 to 2010 (β 0.25, 95% confidence interval [CI] [-1.61 to 2.73]) or within anatomic subgroups. Head CT utilization for the chief complaints of seizure (β -0.97, 95% CI [-1.44 to -0.90]) and head injury (β -0.93, 95% CI [-1.71 to -0.73]) showed significant declines. Although there was no change in the abdominal CT utilization rate for abdominal pain, abdominal ultrasound utilization for abdominal pain significantly increased (β 0.89, 95% CI [0.25-0.79]). CONCLUSIONS Our data showed no overall increase in CT utilization through 2010. In areas where alternative non-radiation-based modalities were options, there were decreased CT trends and increased use of potential alternative non-radiation-based modalities. This is the first large PED cohort study to show a decrease in CT utilization in recent years in a regional pediatric referral center and may correlate with increased awareness of radiation risk in children.
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Affiliation(s)
- Margaret J A Menoch
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.
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Informed consent for computed tomography. Am J Emerg Med 2011; 29:230-2. [DOI: 10.1016/j.ajem.2010.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2010] [Revised: 09/02/2010] [Accepted: 09/05/2010] [Indexed: 11/19/2022] Open
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Lee J, Kirschner J, Pawa S, Wiener DE, Newman DH, Shah K. Computed Tomography Use in the Adult Emergency Department of an Academic Urban Hospital From 2001 to 2007. Ann Emerg Med 2010; 56:591-6. [DOI: 10.1016/j.annemergmed.2010.05.027] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Revised: 05/06/2010] [Accepted: 05/18/2010] [Indexed: 11/25/2022]
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Roudsari B, Moore DS, Jarvik JG. Trend in the Utilization of CT for Adolescents Admitted to an Adult Level I Trauma Center. J Am Coll Radiol 2010; 7:796-801. [DOI: 10.1016/j.jacr.2010.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 05/03/2010] [Indexed: 10/24/2022]
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Romano S, Romano L. Utilization Patterns of Multidetector Computed Tomography in Elective and Emergency Conditions: Indications, Exposure Risk, and Diagnostic Gain. Semin Ultrasound CT MR 2010; 31:53-6. [DOI: 10.1053/j.sult.2009.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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