Abstract：
BACKGROUND. Increases in the use of CT to evaluate patients presenting with trauma have raised concern about inappropriate imaging. The evolving utilization of CT for trauma evaluation may be impacted by injury severity. OBJECTIVE. The purpose of this study was to explore patterns in utilization of chest and abdominopelvic CT among trauma-related emergency department (ED) visits across the United States. METHODS. This retrospective study was conducted with national commercial claims information extracted from the MarketScan Commercial Database. Trauma-related ED encounters were identified from the 2011-2018 MarketScan database files and classified by injury severity score (minor, intermediate, and major injuries) on the basis of International Classification of Diseases codes. ED encounters were also assessed for chest CT, abdominopelvic CT, and single-encounter chest and abdominopelvic CT examinations. Utilization per 1000 trauma-related ED encounters was determined. Multivariable Poisson regression models were used to determine incidence rate ratios (IRRs) as a measure of temporal changes in utilization. RESULTS. From 2011 to 2018, 8,369,092 trauma-related ED encounters were identified (5,685,295 for minor, 2,624,944 for intermediate, and 58,853 for major injuries). Utilization of chest CT per 1000 trauma-related ED encounters increased from 4.9 to 13.5 examinations (adjusted IRR, 1.15 per year; minor injuries, from 2.2 to 7.7 [adjusted IRR, 1.17]; intermediate injuries, from 8.5 to 21.5 [adjusted IRR, 1.16]; major injuries, from 117.8 to 200.1 [adjusted IRR, 1.08]). Utilization of abdominopelvic CT per 1000 trauma-related ED encounters increased from 7.5 to 16.4 (adjusted IRR, 1.12; minor injuries, 4.8 to 12.2 [adjusted IRR, 1.13]; intermediate injuries, 10.6 to 21.7 [adjusted IRR, 1.13]; major injuries, 134.8 to 192.6 [adjusted IRR, 1.07]). Utilization of single-encounter chest and abdominopelvic CT per 1000 trauma-related ED encounters increased from 3.4 to 8.9 [adjusted IRR, 1.16; minor injuries, 1.1 to 4.6 [adjusted IRR, 1.18]; intermediate injuries, 6.4 to 16.4 [adjusted IRR, 1.16]; major injuries, 99.6 to 179.9 [adjusted IRR, 1.08]). CONCLUSION. National utilization of chest and abdominopelvic CT for trauma-related ED encounters increased among commercially insured patients from 2011 to 2018, particularly for single-encounter chest and abdominopelvic CT examinations and for minor injuries. CLINICAL IMPACT. Given concerns about increased cost and detection of incidental findings, further investigation is warranted to explore the potential benefit of single-encounter chest and abdominopelvic CT examinations of patients with minor injuries and to develop strategies for optimizing appropriateness of imaging orders.
摘要：
背景。使用CT评估创伤患者的增加引起了人们对不适当成像的关注。CT用于创伤评估的发展可能受损伤严重程度的影响。目标。这项研究的目的是探索在美国与创伤相关的急诊科（ED）就诊中胸部和腹骨盆CT的利用方式。方法。这项回顾性研究是根据从MarketScan商业数据库中提取的国家商业索赔信息进行的。从2011-2018年MarketScan数据库文件中识别出与创伤相关的ED遭遇，并按损伤严重程度评分(轻微，中间,和重大伤害）根据国际疾病分类代码。还评估了ED遭遇的胸部CT，腹骨盆CT,以及单次胸部和腹骨盆CT检查。确定了每1000次创伤相关ED的利用率。使用多变量泊松回归模型来确定发病率比率（IRR），以衡量利用率的时间变化。结果。从2011年到2018年，确定了8,369,092例与创伤相关的ED遭遇（未成年人为5,685,295，2,624,944为中间，和58,853的重大伤害)。每1000次创伤相关ED的胸部CT使用率从4.9次增加到13.5次检查（调整后的IRR，每年1.15；轻伤，从2.2到7.7[调整后的内部收益率，1.17]；中伤，从8.5到21.5[调整后的内部收益率，1.16]；重大伤害，从117.8到200.1[调整后的内部收益率，1.08]).每1000次创伤相关ED的腹骨盆CT使用率从7.5增加到16.4（调整后的IRR，1.12；轻伤，4.8至12.2[调整后的内部收益率，1.13]；中伤，10.6至21.7[调整后的内部收益率，1.13]；重大伤害，134.8至192.6[调整后的内部收益率，1.07])。每1000次与创伤相关的ED发作，单次胸部和腹骨盆CT的利用率从3.4增加到8.9[调整后的IRR，1.16；轻伤，1.1至4.6[调整后的内部收益率，1.18]；中伤，6.4至16.4[调整后的内部收益率，1.16]；重大伤害，99.6至179.9[调整后的内部收益率，1.08]).结论。从2011年到2018年，在商业保险患者中，全国范围内对与创伤相关的ED遭遇的胸部和腹骨盆CT的利用有所增加，特别是对于单次遭遇的胸部和腹骨盆CT检查和轻伤。临床影响。考虑到对成本增加和偶然发现的发现的担忧，有必要进一步研究,以探索轻微损伤患者的单次胸部和腹骨盆CT检查的潜在益处,并制定优化成像顺序适当性的策略.
