Factors associated with imaging overuse in the emergency department: A systematic review

Title

Factors associated with imaging overuse in the emergency department: A systematic review

Creator

Tung M; Sharma R; Hinson J S; Nothelle S; Pannikottu J; Segal J B

Publisher

American Journal of Emergency Medicine

Date

2018
2018-02

Description

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 (R) and Embase (R) 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 pretransfer 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. (C) 2017 Elsevier Inc. All rights reserved.

Subject

care; computed-tomography scans; costs; ct; Emergency department; Emergency Medicine; Health; Health care; Imaging; Overuse; patient; physicians; Quality measurement; radiation-exposure; research agenda; retrospective-analysis; transferred trauma patients

Format

Journal Article

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Rights

Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).

Pages

301-309

Issue

2

Volume

36

Citation

Tung M; Sharma R; Hinson J S; Nothelle S; Pannikottu J; Segal J B, “Factors associated with imaging overuse in the emergency department: A systematic review,” NEOMED Bibliography Database, accessed May 14, 2021, https://neomed.omeka.net/items/show/7373.

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