The overwhelming majority (93.8 percent) of patients undergoingcomputed tomography (CT) of the abdomen and pelvis (CTAP) in theemergency department (ED) setting are classified as clinicallycomplex, according to a study in the June issue of the Journal of the American College of Radiology . Clinically complex is used to describe patients who are, based ondocumentation of their ED physician, much sicker than others. Increasing clinical evidence has validated the utility of CTAP in avariety of clinical settings. As a result, the utilization of CTAPhas increased in recent years, in both the ED and a variety ofother settings, resulting in questions regarding theappropriateness of its utilization. "Understanding the complexity of patient encounters in whichadvanced medical imaging services are frequently delivered might beuseful in aiding payers and policymakers in explaining the growthof advanced imaging services over the past decade and determiningthe context in which these examinations are appropriately beingused," said Richard Duszak, Jr., MD, co-author of the study. |
Using the CMS five percent Medicare files for 2007, ED visits for Medicare fee-for-servicebeneficiaries were identified. Contemporaneous ED physicianevaluation and management codes were used as the basis for patientcomplexity categorization. Encounters in which CTAP was performedon the same date of service were identified, and variablesaffecting the utilization of CTAP were analyzed. Results showed that of 1,081,000 ED encounters, 306, 401 (28.3percent) were of lower complexity and 774, 599 (71.7 percent) wereof higher complexity. CT of the abdomen and pelvis was performed in65,273 of all encounters (6.0 percent), corresponding to 4,069 (1.3percent) of lower complexity and 61,204 (7.9 percent) of highercomplexity encounters.
Of the 65,273 encounters associated withCTAP, 61,204 (93.8 percent) were of higher complexity. "The utilization of advanced medical imaging in the ED settingserves many valuable roles. CT of the abdomen and pelvis canfacilitate patient triage, decrease ED patient waiting times,decrease hospital lengths of stay and reduce the need forexploratory surgery. These outcomes would favor a preferential rolefor CTAP in sicker and more complex patients, and our resultssupport that belief," said Duszak. Additional References Citations.
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