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An algorithm’s effect on CT use in the emergency department.
The implementation of a clinical triaging algorithm decreases the use of multidetector CT in patients who present to the ED with blunt abdominopelvic trauma (BAPT), according to a study published in Radiology.
Researchers from Boston University Medical Center in Massachusetts and Palantir Technologies, in Palo Alto, California, evaluated the effect of an institutional clinical triaging algorithm on the rate of multidetector CT utilization in BAPT.
The study included 13,096 patients who presented at an urban level I trauma center over an eight-year period with BAPT. The patients ranged in age from 15 to 95 (mean age 42). These patients were divided into two groups: those who were admitted between January 1, 2006 to June 30, 2010, before the algorithm was implemented (the prealgorithm group) and after implementation, which was from July 1, 2010 to December 31, 2013 (the postalgorithm group). Parameters were recorded from abdominopelvic CT study reports for the pre- and postalgorithm groups: number of abdominopelvic CT examinations at admission, number of abdominopelvic CT examinations with positive BAPT-related findings, injury severity score, length of hospital stay, and number of mortalities.
The results showed there was a 32.1% decrease in use of CT following implementation of the algorithm:
|Prealgorithm Group||Postalgorithm Group|
|Patients who underwent abdominopelvic CT examination||76.7% (5,900 of 7,688)||44.6% (2,413 of 5,408)|
|Mean injury severity score||10.1 ± 9.1 (standard deviation)||13.3 ± 11.9|
|BAPT-related findings||17.1% (1,007 of 5,900)||19.8% (479 of 2,413)|
|Average length of stay||4.8 days ± 7.0||4.2 days ± 6.2|
|Mortality||3.1% (242 of 7,688)||2.7% (148 of 5,408)|
“The implementation of a clinical triaging algorithm resulted in decreased use of multidetector CT in patients who presented with BAPT to the emergency department,” the researchers concluded.