Variable utilization patterns of computed tomography for rhinosinusitis in emergency departments

• Published in: The Laryngoscope 2017-03, Vol.127 (3), p.537-543
• Main Authors: Sethi, Rosh K.V., Kozin, Elliott D., Naunheim, Matthew R., Rosen, Melissa, Shrime, Mark G., Sedaghat, Ahmad R., Gray, Stacey T.
• Format: Article
• Language: English
• Subjects: Acute Disease; acute rhinosinusitis; Adolescent; Adult; Analysis of Variance; Child; Child, Preschool; Chronic Disease; chronic rhinosinusitis; Cohort Studies; computed tomography; Cost-Benefit Analysis; CT scan; Departments; emergency department; Emergency Service, Hospital - economics; Emergency Service, Hospital - utilization; Female; Hospital Costs; Humans; Infant; Logistic Models; Male; Medical imaging; Multivariate Analysis; Needs Assessment; Outcome Assessment (Health Care); Patients; Retrospective Studies; Rhinitis - diagnostic imaging; Rhinitis - physiopathology; rhinosinusitis; Risk Assessment; Severity of Illness Index; Sinuses; sinusitis; Sinusitis - diagnostic imaging; Sinusitis - physiopathology; Socioeconomic factors; Tomography, X-Ray Computed - economics; Tomography, X-Ray Computed - utilization; United States; Young Adult
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.26217

Objective Computed tomography (CT) use among patients who present to emergency departments (EDs) with rhinosinusitis symptoms is not well described. We aim to: 1) describe sinus CT utilization patterns, and 2) identify predictors of use. We hypothesize that patient symptoms, socioeconomic factors, and gender may influence the decision to obtain a sinus CT scan. Study Design Retrospective review. Methods The Nationwide Emergency Department Sample (2009–2011) was queried for patient encounters with a primary diagnosis of sinusitis (International Classification of Diseases, Ninth Revision, Clinical Modification codes 461*, 473*). Patient demographics, comorbidities, and disposition were obtained. Factors associated with CT scan use were determined by univariable and multivariable logistic regression. Results A total of 2,297,830 visits were attributed to a primary diagnosis of sinusitis. The majority of patients were adult (age > 17) (80.8%) and female (63.7%). Computed tomography imaging was obtained in 56,088 patients (2.4%). In univariable analysis, many socioeconomic factors were predictive of imaging, including private insurance (P < 0.0001), metropolitan patient residence (P < 0.0001), and higher median household income quartile (P < 0.0001). The strongest predictors of CT use in multivariable analysis were history of injury (odds ratio [OR] = 2.82, 95% confidence interval [CI] = 2.43–3.29), headache (OR 2.11, 95% CI 1.02–2.34), Northeast hospital location (vs. Midwest) (OR 1.91, 95% CI 1.46–2.49), and male gender (OR 1.40, 95% CI 1.34–1.47). Conclusions Several socioeconomic, demographic, and geographic factors are associated with sinus CT scan use in the ED for rhinosinusitis. This study has implications for CT imaging guidelines in the ED setting and demonstrates a need for further investigation of healthcare utilization disparities. Level of Evidence 2C. Laryngoscope, 127:537–543, 2017