Abstract：
BACKGROUND: Increases in computed tomography (CT) use may not always reflect clinical need or improve outcomes. This study aimed to demonstrate how population level data can be used to identify variations in care between patient groups, by analysing system-level changes in CT use around the diagnosis of new conditions.
METHODS: Retrospective repeated cross-sectional observational study using West Australian linked administrative records, including 504,723 adults diagnosed with different conditions in 2006, 2012 and 2015. For 90 days pre/post diagnosis, CT use (any and 2+ scans), effective dose (mSv), lifetime attributable risk (LAR) of cancer incidence and mortality from CT, and costs were assessed.
RESULTS: CT use increased from 209.4 per 1000 new diagnoses in 2006 to 258.0 in 2015; increases were observed for all conditions except neoplasms. Healthcare system costs increased for all conditions but neoplasms and mental disorders. Effective dose increased substantially for respiratory (+2.5 mSv, +23.1%, P < 0.001) and circulatory conditions (+2.1 mSv, +15.4%, P < 0.001). The LAR of cancer incidence and mortality from CT increased for endocrine (incidence +23.4%, mortality +18.0%) and respiratory disorders (+21.7%, +23.3%). Mortality LAR increased for circulatory (+12.1%) and nervous system (+11.0%) disorders. The LAR of cancer incidence and mortality reduced for musculoskeletal system disorders, despite an increase in repeated CT in this group.
CONCLUSIONS: Use and costs increased for most conditions except neoplasms and mental and behavioural disorders. More strategic CT use may have occurred in musculoskeletal conditions, while use and radiation burden increased for respiratory, circulatory and nervous system conditions. Using this high-level approach we flag areas requiring deeper investigation into appropriateness and value of care.
METHODS: Retrospective repeated cross-sectional observational study using West Australian linked administrative records, including 504,723 adults diagnosed with different conditions in 2006, 2012 and 2015. For 90 days pre/post diagnosis, CT use (any and 2+ scans), effective dose (mSv), lifetime attributable risk (LAR) of cancer incidence and mortality from CT, and costs were assessed.
RESULTS: CT use increased from 209.4 per 1000 new diagnoses in 2006 to 258.0 in 2015; increases were observed for all conditions except neoplasms. Healthcare system costs increased for all conditions but neoplasms and mental disorders. Effective dose increased substantially for respiratory (+2.5 mSv, +23.1%, P < 0.001) and circulatory conditions (+2.1 mSv, +15.4%, P < 0.001). The LAR of cancer incidence and mortality from CT increased for endocrine (incidence +23.4%, mortality +18.0%) and respiratory disorders (+21.7%, +23.3%). Mortality LAR increased for circulatory (+12.1%) and nervous system (+11.0%) disorders. The LAR of cancer incidence and mortality reduced for musculoskeletal system disorders, despite an increase in repeated CT in this group.
CONCLUSIONS: Use and costs increased for most conditions except neoplasms and mental and behavioural disorders. More strategic CT use may have occurred in musculoskeletal conditions, while use and radiation burden increased for respiratory, circulatory and nervous system conditions. Using this high-level approach we flag areas requiring deeper investigation into appropriateness and value of care.
摘要：
背景：计算机断层扫描（CT）使用的增加可能并不总是反映临床需要或改善结果。这项研究旨在证明如何使用人口水平数据来识别患者群体之间的护理差异。通过分析围绕新情况诊断的CT使用的系统级变化。
方法：使用西澳大利亚州相关行政记录进行回顾性重复横断面观察研究，包括在2006年，2012年和2015年被诊断患有不同疾病的504,723名成年人。诊断前/后90天，CT使用（任何和2+扫描），有效剂量（mSv），来自CT的癌症发病率和死亡率的终生归因风险（LAR），并对成本进行了评估。
结果：CT的使用从2006年的每1000例新诊断的209.4增加到2015年的258.0；除肿瘤外，所有情况均观察到增加。除肿瘤和精神障碍外，所有疾病的医疗保健系统成本都增加了。呼吸道有效剂量大幅增加(+2.5mSv，+23.1%,P<0.001）和循环条件（+2.1mSv，+15.4%,P<0.001)。内分泌肿瘤的CT发病率和死亡率的LAR增加（发病率+23.4%，死亡率+18.0%)和呼吸系统疾病(+21.7%，+23.3%）。死亡率LAR增加循环(+12.1%)和神经系统(+11.0%)疾病。肌肉骨骼系统疾病的癌症发病率和死亡率降低，尽管该组重复CT增加。
结论：除肿瘤、精神和行为障碍外，大多数疾病的使用和费用都增加了。更具战略性的CT使用可能发生在肌肉骨骼疾病中，虽然呼吸系统的使用和辐射负担增加，循环系统和神经系统状况。使用这种高级方法，我们标记了需要对护理的适当性和价值进行更深入调查的领域。
方法：使用西澳大利亚州相关行政记录进行回顾性重复横断面观察研究，包括在2006年，2012年和2015年被诊断患有不同疾病的504,723名成年人。诊断前/后90天，CT使用（任何和2+扫描），有效剂量（mSv），来自CT的癌症发病率和死亡率的终生归因风险（LAR），并对成本进行了评估。
结果：CT的使用从2006年的每1000例新诊断的209.4增加到2015年的258.0；除肿瘤外，所有情况均观察到增加。除肿瘤和精神障碍外，所有疾病的医疗保健系统成本都增加了。呼吸道有效剂量大幅增加(+2.5mSv，+23.1%,P<0.001）和循环条件（+2.1mSv，+15.4%,P<0.001)。内分泌肿瘤的CT发病率和死亡率的LAR增加（发病率+23.4%，死亡率+18.0%)和呼吸系统疾病(+21.7%，+23.3%）。死亡率LAR增加循环(+12.1%)和神经系统(+11.0%)疾病。肌肉骨骼系统疾病的癌症发病率和死亡率降低，尽管该组重复CT增加。
结论：除肿瘤、精神和行为障碍外，大多数疾病的使用和费用都增加了。更具战略性的CT使用可能发生在肌肉骨骼疾病中，虽然呼吸系统的使用和辐射负担增加，循环系统和神经系统状况。使用这种高级方法，我们标记了需要对护理的适当性和价值进行更深入调查的领域。
