Monica Tung1, Ritu Sharma2, Jeremiah S Hinson3, Stephanie Nothelle1, Jean Pannikottu4, Jodi B Segal5. 1. Johns Hopkins University School of Medicine, Department of Medicine, United States. 2. Johns Hopkins University Bloomberg School of Public Health, United States. 3. Johns Hopkins University School of Medicine, Department of Emergency Medicine, United States. 4. Johns Hopkins University School of Medicine, Department of Medicine, United States; Northeastern Ohio Medical University, United States(1). 5. Johns Hopkins University School of Medicine, Department of Medicine, United States; Johns Hopkins University Bloomberg School of Public Health, United States; Johns Hopkins University Center for Health Services and Outcomes Research, United States. Electronic address: jsegal@jhmi.edu.
Abstract
BACKGROUND: Emergency departments (ED) are sites of prevalent imaging overuse; however, determinants that drive imaging in this setting are not well-characterized. We systematically reviewed the literature to summarize the determinants of imaging overuse in the ED. METHODS: We searched MEDLINE® and Embase® from January 1998 to March 2017. Studies were included if they were written in English, contained original data, pertained to a U.S. population, and identified a determinant associated with overuse of imaging in the ED. RESULTS: Twenty relevant studies were included. Fourteen evaluated computerized tomography (CT) scanning in patents presenting to a regional ED who were then transferred to a level 1 trauma center; incomplete transfer of data and poor image quality were the most frequently described reasons for repeat scanning. Unnecessary pre-transfer scanning or repeated scanning after transfer, in multiple studies, was highest among older patients, those with higher Injury Severity Scores (ISS) and those being transferred further. Six studies explored determinants of overused imaging in the ED in varied conditions, with overuse greater in older patients and those having more comorbid diseases. Defensive imaging reportedly influenced physician behavior. Less integration of services across the health system also predisposed to overuse of imaging. CONCLUSIONS: The literature is heterogeneous with surprisingly few studies of determinants of imaging in minor head injury or of spine imaging. Older patient age and higher ISS were the most consistently associated with ED imaging overuse. This review highlights the need for precise definitions of overuse of imaging in the ED.
BACKGROUND: Emergency departments (ED) are sites of prevalent imaging overuse; however, determinants that drive imaging in this setting are not well-characterized. We systematically reviewed the literature to summarize the determinants of imaging overuse in the ED. METHODS: We searched MEDLINE® and Embase® from January 1998 to March 2017. Studies were included if they were written in English, contained original data, pertained to a U.S. population, and identified a determinant associated with overuse of imaging in the ED. RESULTS: Twenty relevant studies were included. Fourteen evaluated computerized tomography (CT) scanning in patents presenting to a regional ED who were then transferred to a level 1 trauma center; incomplete transfer of data and poor image quality were the most frequently described reasons for repeat scanning. Unnecessary pre-transfer scanning or repeated scanning after transfer, in multiple studies, was highest among older patients, those with higher Injury Severity Scores (ISS) and those being transferred further. Six studies explored determinants of overused imaging in the ED in varied conditions, with overuse greater in older patients and those having more comorbid diseases. Defensive imaging reportedly influenced physician behavior. Less integration of services across the health system also predisposed to overuse of imaging. CONCLUSIONS: The literature is heterogeneous with surprisingly few studies of determinants of imaging in minor head injury or of spine imaging. Older patient age and higher ISS were the most consistently associated with ED imaging overuse. This review highlights the need for precise definitions of overuse of imaging in the ED.
Authors: Jesse E Bible; Rishin J Kadakia; Harrison F Kay; Chi E Zhang; Geoffrey E Casimir; Clinton J Devin Journal: Spine (Phila Pa 1976) Date: 2014-02-15 Impact factor: 3.468
Authors: Hemal K Kanzaria; Jerome R Hoffman; Marc A Probst; John P Caloyeras; Sandra H Berry; Robert H Brook Journal: Acad Emerg Med Date: 2015-03-23 Impact factor: 3.451
Authors: Hunter B Moore; Scott B Loomis; Kristen K Destigter; Travis Mann-Gow; Lee Dorf; Mary H Streeter; George M Ebert; Bruce A Crookes; Stephen M Leffler; Michael F O'Keefe; Kalev Freeman Journal: J Trauma Acute Care Surg Date: 2013-03 Impact factor: 3.313
Authors: Ivan K Ip; Louise Schneider; Steven Seltzer; Allen Smith; Jessica Dudley; Andrew Menard; Ramin Khorasani Journal: Am J Med Date: 2013-06-17 Impact factor: 4.965
Authors: Daniel J Morgan; Shannon Brownlee; Aaron L Leppin; Nancy Kressin; Sanket S Dhruva; Les Levin; Bruce E Landon; Mark A Zezza; Harald Schmidt; Vikas Saini; Adam G Elshaug Journal: BMJ Date: 2015-08-25
Authors: Gabrielle C Freire; Christina Diong; Sima Gandhi; Natasha Saunders; Mark I Neuman; Stephen B Freedman; Jeremy N Friedman; Eyal Cohen Journal: CMAJ Open Date: 2022-10-11
Authors: Ali Pourvaziri; Amirkasra Mojtahed; Peter F Hahn; Michael S Gee; Avinash Kambadakone; Dushyant V Sahani Journal: Eur Radiol Date: 2022-09-08 Impact factor: 7.034
Authors: Jesús María Aranaz Andrés; José Lorenzo Valencia-Martín; Jorge Vicente-Guijarro; Cristina Díaz-Agero Pérez; Nieves López-Fresneña; Irene Carrillo; José Joaquín Mira Solves; Sobrina Working Group Journal: Int J Environ Res Public Health Date: 2020-05-19 Impact factor: 3.390
Authors: Ninh Thi Ha; Susannah Maxwell; Max K Bulsara; Jenny Doust; Donald Mcrobbie; Peter O'Leary; John Slavotinek; Rachael Moorin Journal: BMJ Open Date: 2021-11-11 Impact factor: 2.692