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. 2014 Oct;32(10):1253-8.
doi: 10.1016/j.ajem.2014.07.038. Epub 2014 Aug 7.

The association between advanced diagnostic imaging and ED length of stay

Hemal K Kanzaria  1 , Marc A Probst  2 , Ninez A Ponce  3 , Renee Y Hsia  4
Affiliations

The association between advanced diagnostic imaging and ED length of stay

Hemal K Kanzaria et al. Am J Emerg Med. 2014 Oct.

Abstract

Objective: There has been a rise in advanced diagnostic imaging (ADI) use in the emergency department (ED). Increased utilization may contribute to longer length of stay (LOS), but prior reports have not considered improved methods for modeling skewed LOS data.

Methods: The 2010 National Hospital Ambulatory Medical Care Survey data were analyzed by 5 common ED chief complaints. Generalized linear model (GLM) was compared to quantile and ordinary least squares (OLS) regression to evaluate the association between ADI and ED LOS. Receipt of computed tomography or magnetic resonance imaging was the primary exposure. Emergency department LOS was the primary outcome.

Results: Of the 33,685 ED visits analyzed, 17% involved ADI. The median LOS for patients without ADI was 138 minutes compared to 252 minutes for those who received ADI. Overall, GLM offered the most unbiased estimates, although it provided similar adjusted point estimates to OLS for the marginal change in LOS associated with ADI. The effect of imaging differed by LOS quantile, especially for patients with abdominal pain, fever, and back symptoms.

Conclusions: Generalized linear model offered an improved modeling approach compared to OLS and quantile regression. Consideration of such techniques may facilitate a more complete view of the effect of ADI on ED LOS.

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Conflict of interest statement

Support and Disclosures: This work was supported by the Robert Wood Johnson Foundation Clinical Scholars® program and the U.S. Department of Veterans Affairs (Dr. Kanzaria); by grant 5K12 HL109005 from the NHLBI (Dr. Probst); and by grant KL2 RR024130 from the NIH/NCRR/OD UCSF-CTSI and the Robert Wood Johnson Physician Faculty Scholars Program (Dr. Hsia). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of any of the funding agencies. There are no other conflicts of interest.

References

    1. ABIM. ABIM Foundation - The Choosing Wisely Campaign. Available at http://www.choosingwisely.org/. Accessed August 21, 2013.
    1. Baskerville JR. Screening patients with multi-detector computed axial tomography (MDCT): when will we inform patients about the risk of radiation? Emergency medicine journal : EMJ 2008;25:323–4. - PubMed
    1. ACR. Appropriateness Criteria. Available at http://www.acr.org/Quality-Safety/Appropriateness-Criteria Accessed August 21, 2013.
    1. NCHS. National Center for Health Statistics. Health, United States, 2012: With Speacial Feature on Emergency Care. Hyattsville, MD: 2013. Available at http://www.cdc.gov/nchs/data/hus/hus12.pdf - 088. Accessed October 4, 2013. - PubMed
    1. Pines JM. Trends in the rates of radiography use and important diagnoses in emergency department patients with abdominal pain. Medical care 2009;47:782–6. - PubMed

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