Utilization of Chest and Abdominopelvic CT for Traumatic Injury From 2011 to 2018: Evaluation Using a National Commercial Database

Time trend analysis of Injury Severity score of adult trauma patients with emergent CT examination

PURPOSE

Controversy exists about whole-body computed tomography (CT) as a primary screening modality for suspected multiple trauma patients. Therefore, the aim of this study was to analyze time trends of CT examinations for trauma patients in relation to the Injury Severity Score (ISS).

METHODS

We retrospectively analyzed 561 adult trauma patients (mean age = 54 years) who were admitted to the trauma room of our hospital, immediately followed by a CT examination, in 2009, 2013 und 2017. Review of electronic patient charts was performed to determine the cause of injury. ISS was either calculated upon hospital charts and CT imaging reports or documented in the TraumaRegister DGU® for trauma patients with ICU treatment or ISS ≥ 16.

RESULTS

An increasing number of CT examinations of acute trauma patients were performed at our hospital with 117 patients in 2009 compared to 192 in 2013 and 252 in 2017. Their mean age increased (50 years in 2009, 54 in 2013 and 55 in 2017;p = 0.046), whereas their mean ISS decreased over time (15.2 in 2009 compared to 12.1 in 2013 and 10.6 in 2017;p = 0.001), especially in women (15.1 in 2009, 11.8 in 2013 and 7.4 in 2017;p = 0.001 both), younger age groups (18 to 24 years:15.6 in 2009, 6.5 in 2013 and 8.9 in 2017; p = 0.033 and 25 to 49 years:15.0 in 2009, 11.2 in 2013 and 8.3 in 2017;p = 0.001) as well as motor vehicle collision (MVC) victims (16.2 in 2009, 11.8 in 2013 and 6.1 in 2017; p < 0.001). Trauma patients with a high ISS were especially more likely of older age (OR 1.02,p < 0.001) and with the type of incident being a fall (< 3 m: OR3.84,p < 0.001;>3 m: OR6.22,p < 0.001) compared to MVC.

CONCLUSION

Previous studies suggesting a benefit of primary whole-body CT for trauma patients might not reflect the current patient population with decreasing ISS. Especially females, younger age groups and MVC patients might benefit from stricter selection criteria for receiving whole-body CT. Our results also emphasize the importance of prevention of fall or tumble for elderly people.

Turning radiology reports into epidemiological data to track seasonal pulmonary infections and the COVID-19 pandemic

OBJECTIVES

To automatically label chest radiographs and chest CTs regarding the detection of pulmonary infection in the report text, to calculate the number needed to image (NNI) and to investigate if these labels correlate with regional epidemiological infection data.

MATERIALS AND METHODS

All chest imaging reports performed in the emergency room between 01/2012 and 06/2022 were included (64,046 radiographs; 27,705 CTs). Using a regular expression-based text search algorithm, reports were labeled positive/negative for pulmonary infection if described. Data for regional weekly influenza-like illness (ILI) consultations (10/2013-3/2022), COVID-19 cases, and hospitalization (2/2020-6/2022) were matched with report labels based on calendar date. Positive rate for pulmonary infection detection, NNI, and the correlation with influenza/COVID-19 data were calculated.

RESULTS

Between 1/2012 and 2/2020, a 10.8-16.8% per year positive rate for detecting pulmonary infections on chest radiographs was found (NNI 6.0-9.3). A clear and significant seasonal change in mean monthly detection counts (102.3 winter; 61.5 summer; p < .001) correlated moderately with regional ILI consultations (weekly data r = 0.45; p < .001). For 2020-2021, monthly pulmonary infection counts detected by chest CT increased to 64-234 (23.0-26.7% per year positive rate, NNI 3.7-4.3) compared with 14-94 (22.4-26.7% positive rate, NNI 3.7-4.4) for 2012-2019. Regional COVID-19 epidemic waves correlated moderately with the positive pulmonary infection CT curve for 2020-2022 (weekly new cases: r = 0.53; hospitalizations: r = 0.65; p < .001).

CONCLUSION

Text mining of radiology reports allows to automatically extract diagnoses. It provides a metric to calculate the number needed to image and to track the trend of diagnoses in real time, i.e., seasonality and epidemic course of pulmonary infections.

CLINICAL RELEVANCE

Digitally labeling radiology reports represent previously neglected data and may assist in automated disease tracking, in the assessment of physicians' clinical reasoning for ordering radiology examinations and serve as actionable data for hospital workflow optimization.

KEY POINTS

• Radiology reports, commonly not machine readable, can be automatically labeled with the contained diagnoses using a regular-expression based text search algorithm. • Chest radiograph reports positive for pulmonary infection moderately correlated with regional influenza-like illness consultations (weekly data; r = 0.45; p < .001) and chest CT reports with the course of the regional COVID-19 pandemic (new cases: r = 0.53; hospitalizations: r = 0.65; p < 0.001). • Rendering radiology reports into data labels provides a metric for automated disease tracking, the assessment of ordering physicians clinical reasoning and can serve as actionable data for workflow optimization.

Diagnostic Imaging Utilization in the Emergency Department: Recent Trends in Volume and Radiology Work Relative Value Units

PURPOSE

The aim of this study was to quantify and characterize the recent trend in emergency department (ED) imaging volumes and radiology work relative value units (wRVUs) at level I and level III trauma centers.

METHODS

Total annual diagnostic radiology imaging volumes and wRVUs were obtained from level I and level III trauma centers from January 2014 to December 2021. Imaging volumes were analyzed by modality type, examination code, and location. Total annual patient ED encounters (EDEs), annual weighted Emergency Severity Index, and patient admissions from the ED were obtained. Data were analyzed using annual imaging volume or wRVUs per EDE, and percentage change was calculated.

RESULTS

At the level I trauma center, imaging volumes per EDE increased for chest radiography (5.5%), CT (35.5%), and MRI (56.3%) and decreased for ultrasound (-5.9%) from 2014 to 2021. Imaging volumes per EDE increased for ultrasound (10.4%), CT (74.6%), and MRI (2.0%) and decreased for chest radiography (-4.4%) at the level III trauma center over the same 8-year period. Total wRVUs per EDE increased at both the level I (34.9%) and level III (76.6%) trauma centers over the study period.

CONCLUSIONS

ED imaging utilization increased over the 8-year study period at both level I and level III trauma centers, with an increase in total wRVUs per EDE. There was a disproportionate increased utilization of advanced imaging, such as CT, over time. ED utilization trends suggest that there will be a continued increase in demand for advanced imaging interpretation, including at lower acuity hospitals, so radiology departments should prepare for this increased work demand.