Retrospective analysis of the effectiveness of radiological imaging requests requested in the emergency department

Introduction Advanceimagingutilizationsuch as computedtomography (CT) andmagneticresonanceimaging (MRI) has increased in theemergencydepartment (ED) in developedcountrieswithdisproportiontogrowth in emergencydepartment (ED)patientvolume. Theavailability of CT and MRI scannersmayhavecreated a supply-induceddemand, whichmaycontributetoincreaseduseandvariability in practicewithout a correspondingincrease in quality of care. Thisstudyaimedtoevaluatetheappropriateness of CT and MRI requested in theED. MaterialandMethods Patientswitha diagnostic CT ordiffusionMRI examination, whoappliedtothe Adıyaman Training andResearchHospitalAdultEmergencyDeparmentbetweenJuly 2019 andAugust 2019, wereincluded.Thestudywasperformedwith2012 patientswith CT and 309 patientswithdiffusionMRI. Theresults of CT and MRI wereanalyzedretrospectivelyforthe presence of anyclinicalpathology. Results Theaverageage of 2321 patientsincluded in thestudywas 41.3 ± 26.6years (range 0-100). 51.2% of thepatientsweremaleand 48.8% werefemale. Imagingexaminationwasrequestedbythe general practitioner in 53.3% andbytheemergencymedicinespecialist in 46.7%. Pathologywasobserved in 23.9% of CT imagingand 19.1% of MRI (overall 23.3%).Themostcommontype of CT wascranial CT (n = 1302), followedbyabdominopelvic (n = 503), thorax (n = 253), spine (n = 127) andextremity (n = 101) CTimaging.Themostfrequentpathologies presence is observed in abdominopelvic CT (54.9%), thorax CT (41.5%) andmaxillofacial CT (37.5%), whiletheleastpresence of pathology isobserved inorbital CT (0%), cranial CT (11.1%) andlimb CT (21.6%).21.8% of patientswith CT werebetween 0-10 yearsold, no MRIwasrequiredfromanyone in thisagegroup. While 61.1% of patientswith MRI wereover60years, 24.2% of patientswith CTimagingwereover 60years. Thefrequency of pathologypresence waslower in patients in the 0-10 agegroupcomparedtootheragegroups in CT imaging (p<0,001).Themeanage of patientswithpathology in CTor MRIimagingwassignificantlyhigherthanpatientswithoutpathology(p <0.001, p = 0.039, respectively). Thefrequency of pathology presencewassignificantlyhigher in CT or MRIexaminationsrequestedbyemergencymedicinespecialiststhanrequestedbygeneral practitioners(p <0.001, p = 0.020, respectively). Diffusion MRI costwithoutpathologywascalculated as 32,500,00 TL and CT costwithoutpathologywascalculated as 287,643,00 TL. Conclusion Diagnosticimagingalgorithmsin ED must be followedandadvancedimagingexaminationshould be performedwithappropriatetechniques, protocolsandoptimization of dose, as there is nopathological CT or MRI finding in majority of patients. Thecauses of frequent CT and MRIutilisation in the ED should be investigated. Themoreselectiveuse of advancedimagingmethods in the ED has a potentialtosignificantlyreducehealthcarecosts. KeyWords:Emergencydepartment, computedtomography, magneticresonanceimaging, appropriateness