Advanced imaging and trends in hospitalizations from the emergency department

• Published in: PloS one 2020-09, Vol.15 (9), p.e0239059-e0239059
• Main Authors: Chou, Shih-Chuan, Nagurney, Justine M, Schuur, Jeremiah D, Weiner, Scott G
• Format: Article
• Language: English
• Subjects: Biology and Life Sciences; Computed tomography; Cost control; Diagnostic imaging; Emergency medical care; Emergency medical services; Ethnicity; Government programs; Hispanic people; Hospital emergency services; Hospitalization; Hospitals; Magnetic resonance; Magnetic resonance imaging; Medicaid; Medical imaging; Medicare; Medicine; Medicine and Health Sciences; Patients; Polls & surveys; Regression analysis; Research and Analysis Methods; Statistics; Trends; Ultrasonic imaging; Ultrasound; User statistics
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0239059

The proportion of US emergency department (ED) visits that lead to hospitalization has declined over time. The degree to which advanced imaging use contributed to this trend is unknown. Our objective was to examine the association between advanced imaging use during ED visits and changes in ED hospitalization rates between 2007-2008 and 2015-2016. We analyzed data from the National Hospital Ambulatory Medical Care Survey. The primary outcome was ED hospitalization, including admission to inpatient and observation units and outside transfers. The primary exposure was advanced imaging during the ED visit, including computed tomography, magnetic resonance imaging, and ultrasound. We constructed a survey-weighted multivariable logistic regression with binary outcome of ED hospitalization to examine changes in adjusted hospitalization rates from 2007-2008 to 2015-2016, comparing ED visits with and without advanced imaging. ED patients who received advanced imaging (versus those who did not) were more likely to be 65 years or older (25.3% vs 13.0%), non-Hispanic white (65.3% vs 58.5%), female (58.4% vs 54.1%), and have Medicare (26.5% vs 16.0%). Among ED visits with advanced imaging, adjusted annual hospitalization rate declined from 22.5% in 2007-2008 to 17.3% (adjusted risk ratio [aRR] 0.77; 95% CI 0.68, 0.86) in 2015-2016. In the same periods, among ED visits without advanced imaging, adjusted annual hospitalization rate declined from 14.3% to 11.6% (aRR 0.81; 95% CI 0.73, 0.90). The aRRs between ED visits with and without advanced imaging were not significantly different. From 2007-2016, ED visits with advanced imaging did not have a greater reduction in admission rate compared to those without advanced imaging. Our results suggest that increasing advanced imaging use likely had a limited role in the general decline in hospital admissions from EDs. Future research is needed to further validate this finding.