Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Multicenter Study
Pre and post transfer computed tomography imaging in Canadian trauma centers: a multi-center retrospective cohort study.
Multiple clinical practice guidelines recommend minimizing radiation in trauma patients but there is a knowledge gap on the importance of this problem for trauma transfers. We aimed to estimate the incidence of pretransfer and repeat posttransfer computed tomography (CT) overall and in patients with an indication for immediate transfer, to assess interhospital practice variation, to identify predictors, and to quantify the influence of pretransfer CT on time to transfer. Methods We conducted a retrospective multicenter cohort study on patients transferred to major trauma centers from 2013 to 2019. Multilevel generalized linear regression was used to generate intraclass correlation coefficients (ICCs) to assess interhospital variation, multilevel logistic regression to generate odds ratios for each predictor, and geometric mean ratios to quantify the influence of CT on time to transfer. Results Of 18,244 patients included, 8501 (47%) had a pretransfer CT and one-quarter (26%) had a repeat posttransfer CT. Interhospital variation was moderate for pretransfer CT (5%-66%, ICC 12.5%) and for repeat posttransfer CT (7%-44%, ICC 14.7%). Pretransfer imaging was more frequent in elders and in males and repeat posttransfer imaging decreased over the study period but was more frequent in patients transferred in from Level III/IV centers than nondesignated hospitals. Time to transfer was doubled in patients who had a pretransfer CT. ⋯ Results suggest that pretransfer CT and repeat posttransfer CT are frequent and are subject to significant practice variation. In addition, pretransfer CT is associated with increased times to transfer though additional studies are needed to demonstrate causation. These results highlight potential opportunities to reduce low-value imaging for trauma transfers.
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Observational Study
Association Between Advanced Image Ordered in the Emergency Department on Subsequent Imaging for Abdominal Pain Patients.
Abdominal pain is associated with high rates of emergency department (ED) imaging utilization and revisits. While imaging often improves diagnosis, a better understanding is needed on when the decision to image is justified and how it influences subsequent resource utilization and outcomes for patients in the ED presenting with abdominal pain. We evaluated the association between advanced ED imaging on subsequent outpatient imaging and on revisits among abdominal pain patients discharged from the ED. ⋯ Abdominal imaging in the ED was associated with significantly lower imaging utilization after discharge and 30-day revisit rates, suggesting that imaging in the ED may replace downstream outpatient imaging.
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There are disparities in pain management for children presenting to the emergency department (ED) according to their racial and ethnic backgrounds. It is not known if there are differences in the treatment of pain associated with pediatric migraines by race, ethnicity, and language for care (REaL). ⋯ These data align with previous studies on pain management disparities and highlight another area where we must improve equity for patients in the ED.