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- Title
Radiologists predict differential resource utilization but not clinical outcome in emergency department patients imaged with ultrasound for right upper quadrant pain.
- Authors
Gaur, Sonia; Troost, Jonathan P.; Fung, Christopher M.; Breeden, Joshua; Barkmeier, Daniel; Shankar, Prasad R.; Khalatbari, Shokoufeh; Davenport, Matthew S.
- Abstract
Purpose: Radiologists with diverse training, specialization, and habits interpret imaging in the Emergency Department. It is necessary to understand if their variation predicts differential value. The purpose of this study was to determine whether attending radiologist variation predicts major clinical outcomes in adult Emergency Department patients imaged with ultrasound for right upper quadrant pain. Methods: Consecutive ED patients imaged with ultrasound for RUQ pain from 10/8/2016 to 8/10/2022 were included (N = 7097). The primary outcome was prediction of hospital admission by signing attending radiologist. Secondary outcomes included: ED and hospital length of stay (LOS), 30-day mortality, 30-day re-presentation rate, subspecialty consultation, advanced imaging follow up (HIDA, MRI, CT), and intervention (ERCP, drainage or surgery). Sample size was determined a priori (detectable effect size: w = 0.06). Data were adjusted for demographic data, Elixhauser comorbidities, number of ED visits in prior year, clinical data, and system factors (38 covariates). P-values were corrected for multiple comparisons (false discovery rate-adjusted p-values). Results: The included ultrasounds were read by 35 radiologists (median exams/radiologist: 145 [74.5-241.5]). Signing radiologist did not predict hospitalization (p = 0.85), abdominopelvic surgery or intervention within 30 days, re-presentation to the Emergency Department within 30 days, or subspecialty consultation. Radiologist did predict difference in Emergency Department length of stay (p < 0.001) although this difference was small and imprecise. HIDA was mentioned variably by radiologists (range 0–19%, p < 0.001), and mention of HIDA in the ultrasound report increased 10-fold the odds of HIDA being performed in the next 72 h (odds ratio 10.4 [8.0-13.4], p < 0.001). Conclusion: Radiologist variability did not predict meaningful outcome differences for patients with right upper quadrant pain undergoing ultrasound in the Emergency Department, but when radiologists mention HIDA in their reports, it predicts a 10-fold increase in the odds a HIDA is performed. Radiologists are relied on for interpretation that shapes subsequent patient care, and it is important to consider how radiologist variability can influence both outcome and resource utilization. Highlights: Key finding: In 7,097 patients who underwent RUQ ultrasound in the Emergency Department (ED), radiologist variation did not predict major clinical outcomes including hospitalization (p = 0.85), 30-day abdominopelvic surgery or intervention, 30-day re-presentation to the ED, or subspecialty consultation. Radiologists mentioned HIDA variably (0—19%, p < 0.001), and inclusion of HIDA in ultrasound reports predicted a 10-fold increase in the odds of HIDA being performed in the next 72 h (p < 0.001). Importance: Mention of HIDA in ED right upper quadrant ultrasound reports predicts a 10-fold increase in HIDA utilization, but radiologist variation does not predict differences in major clinical outcomes.
- Subjects
TREATMENT effectiveness; HOSPITAL emergency services; ULTRASONIC imaging; RADIOLOGISTS; EMERGENCY room visits; MAGNETIC resonance imaging
- Publication
Abdominal Radiology, 2024, Vol 49, Issue 6, p2145
- ISSN
2366-004X
- Publication type
Article
- DOI
10.1007/s00261-024-04244-5