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. 2018 Sep;19(5):782-796.
doi: 10.5811/westjem.2018.6.37381. Epub 2018 Jul 26.

Emergency Department Computed Tomography Use for Non-traumatic Abdominal Pain: Minimal Variability

Roderick Cross  1 , Rahul Bhat  1 , Ying Li  2 , Michael Plankey  2 , Kevin Maloy  1
Affiliations

Emergency Department Computed Tomography Use for Non-traumatic Abdominal Pain: Minimal Variability

Roderick Cross et al. West J Emerg Med. 2018 Sep.

Abstract

Introduction: Variability in the use of computed tomography (CT) between providers in the emergency department (ED) suggests that CT is ordered on a provider rather than a patient level. We aimed to evaluate the variability of CT ordering practices for non-traumatic abdominal pain (NTAP) across physicians in the ED using patient-visit and physician-level factors.

Methods: We conducted a retrospective study among 6,409 ED visits for NTAP from January 1 to December 31, 2012, at a large, urban, academic, tertiary-care hospital. We used a two-level hierarchical logistic regression model to estimate inter-physician variation. Intraclass correlation coefficient (ICC) was calculated.

Results: The hierarchical logistic regression analyses showed that patient-visit factors including younger age, arrival mode by ambulance, prior CT, >79 ED arrivals in the previous four hours, and ultrasound had statistically significant negative associations with physician CT ordering, while surgical team admission and white blood count (WBC) >12.5 K/millimeter cubed (mm3) had statistically significant positive associations with physician CT ordering. With physician-level factors, only physicians with >21 years experience after medical school graduation showed statistical significance negatively associated with physician CT ordering. Our data demonstrated increased CT ordering from the mean in only one out of 43 providers (2.3%), which indicated limited variation across physicians to order CT. After adjusting for patient-visit and physician-level factors, the calculated ICC was 1.46%.

Conclusion: We found minimal physician variability in CT ordering practices for NTAP. Patient-visit factors such as age, arrival mode, admission team, prior CT, ED arrivals in previous four hours, ultrasound, and WBC count were found to largely influence CT ordering practices.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Figures

Figure 1
Figure 1
Flow chart of sampling procedure for excluding patient visits from a study on use of computed tomography for chief complaint of non-traumatic abdominal pain.
Figure 2
Figure 2
A) Observed and predicted computed tomography (CT) ordering percentage for each physician; B) Estimated odds ratio of each physician for the tendency to order CT. (All predicted and estimated values were from the hierarchical model.) CI, confidence interval.
See this image and copyright information in PMC

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