背景:COVID-19大流行的爆发对医疗保健服务的消费产生了重大影响。常规诊断检查使用的变化,急性后COVID-19综合征(PCS)的发病率增加,和其他大流行相关因素可能影响检测到的临床状况。
目的:本研究旨在分析COVID-19对门诊医学影像服务的使用及其临床发现的影响,特别关注以色列COVID-19疫苗接种运动启动后的时间段。此外,这项研究测试了观察到的异常发现的增加是否可能与PCS或COVID-19疫苗接种有关.
方法:我们的数据集包括国家卫生组织从2019年1月1日至2021年8月31日的572,480名动态医学成像患者。我们比较了大流行之前和之后的不同医学影像利用指标和临床发现,以确定显着变化。我们还检查了大流行期间在调整医学影像利用变化后异常发现率的变化。最后,对于显示异常发现率增加的成像类,我们测量了SARS-CoV-2感染之间的因果关系,COVID-19相关住院(提示COVID-19并发症),和COVID-19疫苗接种和未来异常发现的风险。为了适应多种混杂因素,我们使用了因果推断方法。
结果:由于第一次COVID-19波而导致常规医学成像的利用率最初下降后,这些检查的数量有所增加,但老年患者的比例较低,有合并症的患者,女人,和疫苗犹豫的患者。此外,我们观察到异常发现率的显著提高,特别是在肌肉骨骼磁共振(MR-MSK)和脑计算机断层扫描(CT-brain)检查中。在调整医学成像利用率的变化后,这些结果也仍然存在。已证明的因果关联包括:SARS-CoV-2感染增加了CT-脑部检查异常发现的风险(比值比[OR]1.4,95%CI1.1-1.7)和COVID-19相关住院增加了MR-MSK检查异常发现的风险(OR3.1,95%CI1.9-5.3)。
结论:COVID-19影响了动态影像学检查的使用,在COVID-19并发症风险较高的患者中避免更多:老年患者,有合并症的患者,和未接种疫苗的患者。因果分析结果表明,PCS可能有助于在MR-MSK和CT脑部检查中观察到的异常发现的增加。
BACKGROUND: The outbreak of the COVID-19 pandemic had a major effect on the consumption of health care services. Changes in the use of routine diagnostic exams, increased incidences of postacute COVID-19 syndrome (PCS), and other pandemic-related factors may have influenced detected clinical conditions.
OBJECTIVE: This study aimed to analyze the impact of COVID-19 on the use of outpatient medical imaging services and clinical findings therein, specifically focusing on the time period after the launch of the Israeli COVID-19 vaccination campaign. In addition, the study tested whether the observed gains in abnormal findings may be linked to PCS or COVID-19 vaccination.
METHODS: Our data set included 572,480 ambulatory medical imaging patients in a national health organization from January 1, 2019, to August 31, 2021. We compared different measures of medical imaging utilization and clinical findings therein before and after the surge of the pandemic to identify significant changes. We also inspected the changes in the rate of abnormal findings during the pandemic after adjusting for changes in medical imaging utilization. Finally, for imaging classes that showed increased rates of abnormal findings, we measured the causal associations between SARS-CoV-2 infection, COVID-19-related hospitalization (indicative of COVID-19 complications), and COVID-19 vaccination and future risk for abnormal findings. To adjust for a multitude of confounding factors, we used causal inference methodologies.
RESULTS: After the initial drop in the utilization of routine medical imaging due to the first COVID-19 wave, the number of these exams has increased but with lower proportions of older patients, patients with comorbidities, women, and vaccine-hesitant patients. Furthermore, we observed significant gains in the rate of abnormal findings, specifically in musculoskeletal magnetic resonance (MR-MSK) and brain computed tomography (CT-brain) exams. These results also persisted after adjusting for the changes in medical imaging utilization. Demonstrated causal associations included the following: SARS-CoV-2 infection increasing the risk for an abnormal finding in a CT-brain exam (odds ratio [OR] 1.4, 95% CI 1.1-1.7) and COVID-19-related hospitalization increasing the risk for abnormal findings in an MR-MSK exam (OR 3.1, 95% CI 1.9-5.3).
CONCLUSIONS: COVID-19 impacted the use of ambulatory imaging exams, with greater avoidance among patients at higher risk for COVID-19 complications: older patients, patients with comorbidities, and nonvaccinated patients. Causal analysis results imply that PCS may have contributed to the observed gains in abnormal findings in MR-MSK and CT-brain exams.