Overuse of plain abdominal radiography in emergency departments: a retrospective cohort study
Abstract Background Plain abdominal radiography (PAR) is routinely performed in emergency departments (EDs). This study aimed to (1) identify the indications for PAR in EDs and compare them against international guidelines, (2) uncover predictors of non-compliance with guidelines, and (3) describe t...
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doaj-856106823a1644c599f9f9701cc956ad2020-11-25T01:13:46ZengBMCBMC Health Services Research1472-69632019-01-011911710.1186/s12913-019-3870-2Overuse of plain abdominal radiography in emergency departments: a retrospective cohort studyChristophe L. Bertin0Simon Ponthus1Hari Vivekanantham2Pierre-Alexandre Poletti3Omar Kherad4Olivier T. Rutschmann5Division of Emergency Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals and School of Medicine, Geneva UniversityDivision of Internal Medicine, Hôpital de la TourDivision of Internal Medicine, Hôpital de la TourDivision of Emergency Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals and School of Medicine, Geneva UniversityDivision of Internal Medicine, Hôpital de la Tour and School of MedicineDivision of Emergency Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals and School of Medicine, Geneva UniversityAbstract Background Plain abdominal radiography (PAR) is routinely performed in emergency departments (EDs). This study aimed to (1) identify the indications for PAR in EDs and compare them against international guidelines, (2) uncover predictors of non-compliance with guidelines, and (3) describe the use of additional radiological examinations in EDs. Methods Retrospective cohort study in the EDs of two hospitals in Geneva, Switzerland, including all adult patients who underwent PAR in the EDs. Indications were considered “appropriate” if complying with guidelines. Predictors of non-compliance were identified by univariate and multivariate analyses. Results Over 1 year, PAR was performed in 1997 patients (2.2% of all admissions). Their mean age was 59.7 years, with 53.1% of female patients. The most common indications were constipation (30.8%), suspected ileus (28.9%), and abdominal pain (15.3%). According to the French and American guidelines, only 11.8% of the PARs were indicated, while 46.2% of them complied with the Australian and British guidelines. On multivariate analysis, admission to the private hospital ED (odds ratio [OR] 3.88, 95% CI 1.78–8.45), female gender (OR 1.95, 95% CI 1.46–2.59), and an age > 65 years (OR 2.41, 95%CI 1.74–3.32) were associated with a higher risk of inappropriate PAR. Additional radiological examinations were performed in 73.7% of patients. Conclusions Most indications for PAR did not comply with guidelines and elderly women appeared particularly at risk of being exposed to inappropriate examination. PAR did not prevent the need for additional examinations. Local guidelines should be developed, and initiatives should be implemented to reduce unnecessary PARs. Trial registration ClinicalTrials.gov, identifier NCT02980081.http://link.springer.com/article/10.1186/s12913-019-3870-2Plain X-rayAbdomenEmergency department |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Christophe L. Bertin Simon Ponthus Hari Vivekanantham Pierre-Alexandre Poletti Omar Kherad Olivier T. Rutschmann |
spellingShingle |
Christophe L. Bertin Simon Ponthus Hari Vivekanantham Pierre-Alexandre Poletti Omar Kherad Olivier T. Rutschmann Overuse of plain abdominal radiography in emergency departments: a retrospective cohort study BMC Health Services Research Plain X-ray Abdomen Emergency department |
author_facet |
Christophe L. Bertin Simon Ponthus Hari Vivekanantham Pierre-Alexandre Poletti Omar Kherad Olivier T. Rutschmann |
author_sort |
Christophe L. Bertin |
title |
Overuse of plain abdominal radiography in emergency departments: a retrospective cohort study |
title_short |
Overuse of plain abdominal radiography in emergency departments: a retrospective cohort study |
title_full |
Overuse of plain abdominal radiography in emergency departments: a retrospective cohort study |
title_fullStr |
Overuse of plain abdominal radiography in emergency departments: a retrospective cohort study |
title_full_unstemmed |
Overuse of plain abdominal radiography in emergency departments: a retrospective cohort study |
title_sort |
overuse of plain abdominal radiography in emergency departments: a retrospective cohort study |
publisher |
BMC |
series |
BMC Health Services Research |
issn |
1472-6963 |
publishDate |
2019-01-01 |
description |
Abstract Background Plain abdominal radiography (PAR) is routinely performed in emergency departments (EDs). This study aimed to (1) identify the indications for PAR in EDs and compare them against international guidelines, (2) uncover predictors of non-compliance with guidelines, and (3) describe the use of additional radiological examinations in EDs. Methods Retrospective cohort study in the EDs of two hospitals in Geneva, Switzerland, including all adult patients who underwent PAR in the EDs. Indications were considered “appropriate” if complying with guidelines. Predictors of non-compliance were identified by univariate and multivariate analyses. Results Over 1 year, PAR was performed in 1997 patients (2.2% of all admissions). Their mean age was 59.7 years, with 53.1% of female patients. The most common indications were constipation (30.8%), suspected ileus (28.9%), and abdominal pain (15.3%). According to the French and American guidelines, only 11.8% of the PARs were indicated, while 46.2% of them complied with the Australian and British guidelines. On multivariate analysis, admission to the private hospital ED (odds ratio [OR] 3.88, 95% CI 1.78–8.45), female gender (OR 1.95, 95% CI 1.46–2.59), and an age > 65 years (OR 2.41, 95%CI 1.74–3.32) were associated with a higher risk of inappropriate PAR. Additional radiological examinations were performed in 73.7% of patients. Conclusions Most indications for PAR did not comply with guidelines and elderly women appeared particularly at risk of being exposed to inappropriate examination. PAR did not prevent the need for additional examinations. Local guidelines should be developed, and initiatives should be implemented to reduce unnecessary PARs. Trial registration ClinicalTrials.gov, identifier NCT02980081. |
topic |
Plain X-ray Abdomen Emergency department |
url |
http://link.springer.com/article/10.1186/s12913-019-3870-2 |
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