Redundant Imaging in Transient Ischemic Attack: Evidence From the Nationwide Emergency Department Sample
Increasing emergency department (ED) compliance with transient ischemic attack (TIA) imaging guidelines has previously been demonstrated, along with a substantial rise in imaging utilization over the past decade. The purpose of this study was to characterize the most commonly used combinations of im...
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| Veröffentlicht in: | Journal of the American College of Radiology 2021-11, Vol.18 (11), p.1525-1531 |
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| creator | Timpone, Vincent M. Jensen, Alexandria Poisson, Sharon N. Reid, Margaret Salzberg, Matthew Trivedi, Premal S. |
| description | Increasing emergency department (ED) compliance with transient ischemic attack (TIA) imaging guidelines has previously been demonstrated, along with a substantial rise in imaging utilization over the past decade. The purpose of this study was to characterize the most commonly used combinations of imaging studies during ED workup of TIA and to quantify prevalence of redundant imaging (RI).
TIA discharges from EDs in the United States from 2006 to 2017 were identified in the Nationwide Emergency Department Sample. Brain and neurovascular imaging obtained during the encounter was identified using Current Procedural Terminology codes. RI was defined as an ED encounter with any duplicate cross-sectional brain, brain-vascular, or neck-vascular imaging. Patient demographics and hospital characteristics were incorporated into a multivariable logistic regression analysis to identify significant associations with RI.
There were 184,870 discharges with TIA from EDs in 2017. RI (brain) was observed in 55,513 (30%) of encounters. RI (brain-vascular) and RI (neck-vascular) imaging was identified in 5,149 (2.8%) and 1,325 (0.7%) of encounters, respectively. Decreased odds of obtaining RI was observed in Medicaid patients (odds ratio [OR]: 0.72, 95% confidence interval [CI]: 0.64-0.81), non–trauma centers (OR: 0.49, 95% CI: 0.26-0.93), rural hospital locations (OR: 0.18, 95% CI: 0.11-0.29), and weekend encounters (OR: 0.9, 95% CI: 0.85-0.96). Trend analysis from 2006 to 2017 demonstrated a rise in RI (brain) from 2.3% of encounters in 2006 to 30% of encounters in 2017. RI for patients discharged from EDs with TIA in 2017 resulted in additional charges of approximately US$8,670,832.
Increased imaging utilization for TIA workup across EDs in the United States is associated with rising use of redundant imaging. We identify imaging practices that could be targeted to mitigate health care expenditures while adhering to TIA imaging guidelines.
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| doi_str_mv | 10.1016/j.jacr.2021.07.003 |
| format | Article |
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TIA discharges from EDs in the United States from 2006 to 2017 were identified in the Nationwide Emergency Department Sample. Brain and neurovascular imaging obtained during the encounter was identified using Current Procedural Terminology codes. RI was defined as an ED encounter with any duplicate cross-sectional brain, brain-vascular, or neck-vascular imaging. Patient demographics and hospital characteristics were incorporated into a multivariable logistic regression analysis to identify significant associations with RI.
There were 184,870 discharges with TIA from EDs in 2017. RI (brain) was observed in 55,513 (30%) of encounters. RI (brain-vascular) and RI (neck-vascular) imaging was identified in 5,149 (2.8%) and 1,325 (0.7%) of encounters, respectively. Decreased odds of obtaining RI was observed in Medicaid patients (odds ratio [OR]: 0.72, 95% confidence interval [CI]: 0.64-0.81), non–trauma centers (OR: 0.49, 95% CI: 0.26-0.93), rural hospital locations (OR: 0.18, 95% CI: 0.11-0.29), and weekend encounters (OR: 0.9, 95% CI: 0.85-0.96). Trend analysis from 2006 to 2017 demonstrated a rise in RI (brain) from 2.3% of encounters in 2006 to 30% of encounters in 2017. RI for patients discharged from EDs with TIA in 2017 resulted in additional charges of approximately US$8,670,832.
Increased imaging utilization for TIA workup across EDs in the United States is associated with rising use of redundant imaging. We identify imaging practices that could be targeted to mitigate health care expenditures while adhering to TIA imaging guidelines.
[Display omitted]</description><identifier>ISSN: 1546-1440</identifier><identifier>EISSN: 1558-349X</identifier><identifier>DOI: 10.1016/j.jacr.2021.07.003</identifier><identifier>PMID: 34329612</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Appropriateness Criteria ; Cross-Sectional Studies ; Emergency Service, Hospital ; Humans ; imaging utilization ; Ischemic Attack, Transient - diagnostic imaging ; Ischemic Attack, Transient - epidemiology ; NEDS ; Odds Ratio ; Patient Discharge ; Retrospective Studies ; Stroke ; transient ischemic attack ; United States - epidemiology</subject><ispartof>Journal of the American College of Radiology, 2021-11, Vol.18 (11), p.1525-1531</ispartof><rights>2021 American College of Radiology</rights><rights>Copyright © 2021 American College of Radiology. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c356t-9ab586f9a6464c789015ed78fb5a394e32b950a704602a1ba1fb87e5825efc613</citedby><cites>FETCH-LOGICAL-c356t-9ab586f9a6464c789015ed78fb5a394e32b950a704602a1ba1fb87e5825efc613</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1546144021005652$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34329612$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Timpone, Vincent M.</creatorcontrib><creatorcontrib>Jensen, Alexandria</creatorcontrib><creatorcontrib>Poisson, Sharon N.</creatorcontrib><creatorcontrib>Reid, Margaret</creatorcontrib><creatorcontrib>Salzberg, Matthew</creatorcontrib><creatorcontrib>Trivedi, Premal S.</creatorcontrib><title>Redundant Imaging in Transient Ischemic Attack: Evidence From the Nationwide Emergency Department Sample</title><title>Journal of the American College of Radiology</title><addtitle>J Am Coll Radiol</addtitle><description>Increasing emergency department (ED) compliance with transient ischemic attack (TIA) imaging guidelines has previously been demonstrated, along with a substantial rise in imaging utilization over the past decade. The purpose of this study was to characterize the most commonly used combinations of imaging studies during ED workup of TIA and to quantify prevalence of redundant imaging (RI).
TIA discharges from EDs in the United States from 2006 to 2017 were identified in the Nationwide Emergency Department Sample. Brain and neurovascular imaging obtained during the encounter was identified using Current Procedural Terminology codes. RI was defined as an ED encounter with any duplicate cross-sectional brain, brain-vascular, or neck-vascular imaging. Patient demographics and hospital characteristics were incorporated into a multivariable logistic regression analysis to identify significant associations with RI.
There were 184,870 discharges with TIA from EDs in 2017. RI (brain) was observed in 55,513 (30%) of encounters. RI (brain-vascular) and RI (neck-vascular) imaging was identified in 5,149 (2.8%) and 1,325 (0.7%) of encounters, respectively. Decreased odds of obtaining RI was observed in Medicaid patients (odds ratio [OR]: 0.72, 95% confidence interval [CI]: 0.64-0.81), non–trauma centers (OR: 0.49, 95% CI: 0.26-0.93), rural hospital locations (OR: 0.18, 95% CI: 0.11-0.29), and weekend encounters (OR: 0.9, 95% CI: 0.85-0.96). Trend analysis from 2006 to 2017 demonstrated a rise in RI (brain) from 2.3% of encounters in 2006 to 30% of encounters in 2017. RI for patients discharged from EDs with TIA in 2017 resulted in additional charges of approximately US$8,670,832.
Increased imaging utilization for TIA workup across EDs in the United States is associated with rising use of redundant imaging. We identify imaging practices that could be targeted to mitigate health care expenditures while adhering to TIA imaging guidelines.
[Display omitted]</description><subject>Appropriateness Criteria</subject><subject>Cross-Sectional Studies</subject><subject>Emergency Service, Hospital</subject><subject>Humans</subject><subject>imaging utilization</subject><subject>Ischemic Attack, Transient - diagnostic imaging</subject><subject>Ischemic Attack, Transient - epidemiology</subject><subject>NEDS</subject><subject>Odds Ratio</subject><subject>Patient Discharge</subject><subject>Retrospective Studies</subject><subject>Stroke</subject><subject>transient ischemic attack</subject><subject>United States - epidemiology</subject><issn>1546-1440</issn><issn>1558-349X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE9v1DAQxS0EoqXwBTggH7kk9X8niEtVtrRSBRIUiZs1cSa7XtbJ1vYW9duTaAtHTjN6896T5kfIW85qzrg539Zb8KkWTPCa2Zox-Yyccq2bSqr25_NlV6biSrET8irnLWPC2qZ5SU6kkqI1XJySzTfsD2MPY6E3EdZhXNMw0rsEYw64iNlvMAZPL0oB_-sDXT2EHkeP9CpNkZYN0i9QwjT-nmW6ipjW8_WRfsI9pBKXiu8Q9zt8TV4MsMv45mmekR9Xq7vL6-r26-eby4vbykttStVCpxsztGCUUd42LeMae9sMnQbZKpSiazUDy5RhAngHfOgai7oRGgdvuDwj74-9-zTdHzAXF0P2uNvBiNMhO6G1FZJrwWarOFp9mnJOOLh9ChHSo-PMLYTd1i2E3ULYMetmwnPo3VP_oYvY_4v8RTobPh4NOH_5EDC57MNCrA8JfXH9FP7X_weTPIy2</recordid><startdate>202111</startdate><enddate>202111</enddate><creator>Timpone, Vincent M.</creator><creator>Jensen, Alexandria</creator><creator>Poisson, Sharon N.</creator><creator>Reid, Margaret</creator><creator>Salzberg, Matthew</creator><creator>Trivedi, Premal S.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202111</creationdate><title>Redundant Imaging in Transient Ischemic Attack: Evidence From the Nationwide Emergency Department Sample</title><author>Timpone, Vincent M. ; Jensen, Alexandria ; Poisson, Sharon N. ; Reid, Margaret ; Salzberg, Matthew ; Trivedi, Premal S.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c356t-9ab586f9a6464c789015ed78fb5a394e32b950a704602a1ba1fb87e5825efc613</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Appropriateness Criteria</topic><topic>Cross-Sectional Studies</topic><topic>Emergency Service, Hospital</topic><topic>Humans</topic><topic>imaging utilization</topic><topic>Ischemic Attack, Transient - diagnostic imaging</topic><topic>Ischemic Attack, Transient - epidemiology</topic><topic>NEDS</topic><topic>Odds Ratio</topic><topic>Patient Discharge</topic><topic>Retrospective Studies</topic><topic>Stroke</topic><topic>transient ischemic attack</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Timpone, Vincent M.</creatorcontrib><creatorcontrib>Jensen, Alexandria</creatorcontrib><creatorcontrib>Poisson, Sharon N.</creatorcontrib><creatorcontrib>Reid, Margaret</creatorcontrib><creatorcontrib>Salzberg, Matthew</creatorcontrib><creatorcontrib>Trivedi, Premal S.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Timpone, Vincent M.</au><au>Jensen, Alexandria</au><au>Poisson, Sharon N.</au><au>Reid, Margaret</au><au>Salzberg, Matthew</au><au>Trivedi, Premal S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Redundant Imaging in Transient Ischemic Attack: Evidence From the Nationwide Emergency Department Sample</atitle><jtitle>Journal of the American College of Radiology</jtitle><addtitle>J Am Coll Radiol</addtitle><date>2021-11</date><risdate>2021</risdate><volume>18</volume><issue>11</issue><spage>1525</spage><epage>1531</epage><pages>1525-1531</pages><issn>1546-1440</issn><eissn>1558-349X</eissn><abstract>Increasing emergency department (ED) compliance with transient ischemic attack (TIA) imaging guidelines has previously been demonstrated, along with a substantial rise in imaging utilization over the past decade. The purpose of this study was to characterize the most commonly used combinations of imaging studies during ED workup of TIA and to quantify prevalence of redundant imaging (RI).
TIA discharges from EDs in the United States from 2006 to 2017 were identified in the Nationwide Emergency Department Sample. Brain and neurovascular imaging obtained during the encounter was identified using Current Procedural Terminology codes. RI was defined as an ED encounter with any duplicate cross-sectional brain, brain-vascular, or neck-vascular imaging. Patient demographics and hospital characteristics were incorporated into a multivariable logistic regression analysis to identify significant associations with RI.
There were 184,870 discharges with TIA from EDs in 2017. RI (brain) was observed in 55,513 (30%) of encounters. RI (brain-vascular) and RI (neck-vascular) imaging was identified in 5,149 (2.8%) and 1,325 (0.7%) of encounters, respectively. Decreased odds of obtaining RI was observed in Medicaid patients (odds ratio [OR]: 0.72, 95% confidence interval [CI]: 0.64-0.81), non–trauma centers (OR: 0.49, 95% CI: 0.26-0.93), rural hospital locations (OR: 0.18, 95% CI: 0.11-0.29), and weekend encounters (OR: 0.9, 95% CI: 0.85-0.96). Trend analysis from 2006 to 2017 demonstrated a rise in RI (brain) from 2.3% of encounters in 2006 to 30% of encounters in 2017. RI for patients discharged from EDs with TIA in 2017 resulted in additional charges of approximately US$8,670,832.
Increased imaging utilization for TIA workup across EDs in the United States is associated with rising use of redundant imaging. We identify imaging practices that could be targeted to mitigate health care expenditures while adhering to TIA imaging guidelines.
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| subjects | Appropriateness Criteria Cross-Sectional Studies Emergency Service, Hospital Humans imaging utilization Ischemic Attack, Transient - diagnostic imaging Ischemic Attack, Transient - epidemiology NEDS Odds Ratio Patient Discharge Retrospective Studies Stroke transient ischemic attack United States - epidemiology |
| title | Redundant Imaging in Transient Ischemic Attack: Evidence From the Nationwide Emergency Department Sample |
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