Radiologists predict differential resource utilization but not clinical outcome in emergency department patients imaged with ultrasound for right upper quadrant pain

Purpose Radiologists with diverse training, specialization, and habits interpret imaging in the Emergency Department. It is necessary to understand if their variation predicts differential value. The purpose of this study was to determine whether attending radiologist variation predicts major clinic...

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Bibliographic Details
Published in:Abdominal imaging 2024-06, Vol.49 (6), p.2145-2154
Main Authors: Gaur, Sonia, Troost, Jonathan P., Fung, Christopher M., Breeden, Joshua, Barkmeier, Daniel, Shankar, Prasad R., Khalatbari, Shokoufeh, Davenport, Matthew S.
Format: Article
Language:English
Subjects:
Abdomen
Clinical outcomes
Comorbidity
Emergency medical care
Emergency medical services
Gastroenterology
Hepatology
Hospitals
Imaging
Length of stay
Medical imaging
Medicine
Medicine & Public Health
Pain
Patients
Practice
Quadrants
Radiology
Resource utilization
Surgery
Ultrasonic imaging
Ultrasound
Variability
Variation
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Summary:Purpose Radiologists with diverse training, specialization, and habits interpret imaging in the Emergency Department. It is necessary to understand if their variation predicts differential value. The purpose of this study was to determine whether attending radiologist variation predicts major clinical outcomes in adult Emergency Department patients imaged with ultrasound for right upper quadrant pain. Methods Consecutive ED patients imaged with ultrasound for RUQ pain from 10/8/2016 to 8/10/2022 were included ( N  = 7097). The primary outcome was prediction of hospital admission by signing attending radiologist. Secondary outcomes included: ED and hospital length of stay (LOS), 30-day mortality, 30-day re-presentation rate, subspecialty consultation, advanced imaging follow up (HIDA, MRI, CT), and intervention (ERCP, drainage or surgery). Sample size was determined a priori (detectable effect size: w  = 0.06). Data were adjusted for demographic data, Elixhauser comorbidities, number of ED visits in prior year, clinical data, and system factors (38 covariates). P-values were corrected for multiple comparisons (false discovery rate-adjusted p-values). Results The included ultrasounds were read by 35 radiologists (median exams/radiologist: 145 [74.5-241.5]). Signing radiologist did not predict hospitalization ( p  = 0.85), abdominopelvic surgery or intervention within 30 days, re-presentation to the Emergency Department within 30 days, or subspecialty consultation. Radiologist did predict difference in Emergency Department length of stay ( p  
ISSN:2366-0058
2366-004X
2366-0058
DOI:10.1007/s00261-024-04244-5