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1.
Rev. Hosp. Ital. B. Aires (2004) ; 41(1): 15-20, mar. 2021. graf, tab
Artigo em Espanhol | LILACS | ID: biblio-1178270

RESUMO

Introducción: los estudios por imágenes (EPI) son de gran ayuda para el diagnóstico clínico, pero su uso irracional puede ocasionar daños. Objetivos: relevar las percepciones y expectativas sobre estudios por imágenes pediátricos en un grupo de padres de niños sanos. Evaluar los datos obtenidos en relación con el registro de EPI solicitados por Guardia durante el mismo período. Materiales y métodos: estudio exploratorio, descriptivo, cuali-cuantitativo mediante una encuesta en una muestra por conveniencia en un centro pediátrico ambulatorio, a lo largo de dos meses. Análisis retrospectivo de solicitud de EPI en el registro informatizado de historias clínicas de Guardia durante el mismo período. Resultados: respondieron 243 padres. El 93,4% refirió conocer métodos de EPI (la radiografía[Rx] fue el más conocido). Se había realizado al menos un EPI al 83,4% de los niños en los últimos doce meses. El estudio fue explicado en forma clara en el 96,4% de los casos. Un 47,7% de los padres refirieron conocer las consecuencias del uso repetitivo de EPI. El 81,6% acordó con que "ante cualquier traumatismo se debe realizar Rx para descartar fractura". Más del 60% consideró que debe realizarse Rx de tórax a todo niño con tos sin fiebre o con fiebre de más de dos días y 55% solicitarían Rx de senos paranasales si el niño elimina mocos verdes. El 49,8% opinó que los médicos piden EPI de menos (por falta de recursos, para trabajar menos o para ahorrar dinero). Durante el período estudiado se solicitó una radiografía al 5% de los pacientes que consultaron por Guardia; no se encontró justificación para solicitar el estudio en el 29% de los casos. Conclusión: un gran porcentaje de padres conoce los EPI; sin embargo, desconocen los riesgos asociados a su uso. Existen errores de concepto que generan expectativas desmedidas con respecto a la indicación de Rx. Se informó un exceso en las solicitudes de EPI por Guardia. Los padres consideran que los médicos solicitan EPI de menos. (AU)


Introduction: ediatric radiologic exams (PRE) are of great value for clinicians. It's over or misuse can lead to irreparable damage that can be prevented. Objective: to describe perceptions and expectations for the use of PRE among healthy children`s parents in an ambulatory center. To analyze these results in relation to the report of PRE performed in the emergency room during the same period. Methods: observational, cross sectional, quali- quantitative study using a survey on a convenience sample conducted in an outpatient pediatric center over a two months period. Retrospective analysis of medical records to evaluate PRE requested on the ER during the 2 months of the study. Results: 243 parents completed the survey. 93,4% were familiar with PRE (X-rays being the most popular among them). 83,4% of children in our sample had at least one PRE in the past 12 months. The need and utility of the study had been explained to the parents clearly in 96,4% of cases. 47,7% of parents knew about the side effects associated with repetitive use of PRE. 81,6% agreed with the statement "in the event that a child should suffer any trauma, an X-Ray should be performed to look for fractures". Over 60% think a chest X ray has to be obtained if the child has fever for over 48 hours and 55% would expect an X ray to be performed whenever a child has green nasal discharge. 49,8% respondents think that doctors order less than necessary (for lack of resources, unwillingness to work in or to save money). The analysis of clinical reports showed that X-Rays were performed to 5% of children at the emergency clinic. Among them, we found no reason for the study in 29% of the cases. Conclusion: we found that parents were very familiar with PRE, however less than half our sample knew of the potential risks related to their use. There are considerable misconceptions among parents regarding X-Ray use. Parents considered that doctors order too little PRE. (AU)


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Pediatria/estatística & dados numéricos , Diagnóstico por Imagem/estatística & dados numéricos , Argentina , Lesões por Radiação/etiologia , Radiação Ionizante , Raios X , Diagnóstico por Imagem/efeitos adversos , Radiografia/estatística & dados numéricos , Risco , Inquéritos e Questionários , Estudos Retrospectivos
2.
JAMA Netw Open ; 4(2): e2037371, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33591367

RESUMO

Importance: Acute low back pain (LBP) is highly prevalent, with a presumed favorable prognosis; however, once chronic, LBP becomes a disabling and expensive condition. Acute to chronic LBP transition rates vary widely owing to absence of standardized operational definitions, and it is unknown whether a standardized prognostic tool (ie, Subgroups for Targeted Treatment Back tool [SBT]) can estimate this transition or whether early non-guideline concordant treatment is associated with the transition to chronic LBP. Objective: To assess the associations between the transition from acute to chronic LBP with SBT risk strata; demographic, clinical, and practice characteristics; and guideline nonconcordant processes of care. Design, Setting, and Participants: This inception cohort study was conducted alongside a multisite, pragmatic cluster randomized trial. Adult patients with acute LBP stratified by SBT risk were enrolled in 77 primary care practices in 4 regions across the United States between May 2016 and June 2018 and followed up for 6 months, with final follow-up completed by March 2019. Data analysis was conducted from January to March 2020. Exposures: SBT risk strata and early LBP guideline nonconcordant processes of care (eg, receipt of opioids, imaging, and subspecialty referral). Main Outcomes and Measures: Transition from acute to chronic LBP at 6 months using the National Institutes of Health Task Force on Research Standards consensus definition of chronic LBP. Patient demographic characteristics, clinical factors, and LBP process of care were obtained via electronic medical records. Results: Overall, 5233 patients with acute LBP (3029 [58%] women; 4353 [83%] White individuals; mean [SD] age 50.6 [16.9] years; 1788 [34%] low risk; 2152 [41%] medium risk; and 1293 [25%] high risk) were included. Overall transition rate to chronic LBP at six months was 32% (1666 patients). In a multivariable model, SBT risk stratum was positively associated with transition to chronic LBP (eg, high-risk vs low-risk groups: adjusted odds ratio [aOR], 2.45; 95% CI, 2.00-2.98; P < .001). Patient and clinical characteristics associated with transition to chronic LBP included obesity (aOR, 1.52; 95% CI, 1.28-1.80; P < .001); smoking (aOR, 1.56; 95% CI, 1.29-1.89; P < .001); severe and very severe baseline disability (aOR, 1.82; 95% CI, 1.48-2.24; P < .001 and aOR, 2.08; 95% CI, 1.60-2.68; P < .001, respectively) and diagnosed depression/anxiety (aOR, 1.66; 95% CI, 1.28-2.15; P < .001). After controlling for all other variables, patients exposed to 1, 2, or 3 nonconcordant processes of care within the first 21 days were 1.39 (95% CI, 1.21-2.32), 1.88 (95% CI, 1.53-2.32), and 2.16 (95% CI, 1.10-4.25) times more likely to develop chronic LBP compared with those with no exposure (P < .001). Conclusions and Relevance: In this cohort study, the transition rate to chronic LBP was substantial and increased correspondingly with SBT stratum and early exposure to guideline nonconcordant care.


Assuntos
Dor Aguda/fisiopatologia , Dor Crônica/fisiopatologia , Dor Lombar/fisiopatologia , Atenção Primária à Saúde , Dor Aguda/diagnóstico por imagem , Dor Aguda/epidemiologia , Dor Aguda/terapia , Adulto , Idoso , Analgésicos Opioides/uso terapêutico , Transtornos de Ansiedade/epidemiologia , Dor Crônica/epidemiologia , Transtorno Depressivo/epidemiologia , Diagnóstico por Imagem/estatística & dados numéricos , Progressão da Doença , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Dor Lombar/diagnóstico por imagem , Dor Lombar/epidemiologia , Dor Lombar/terapia , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Razão de Chances , Guias de Prática Clínica como Assunto , Prognóstico , Encaminhamento e Consulta/estatística & dados numéricos , Fatores de Risco , Fumar/epidemiologia , Estados Unidos/epidemiologia
3.
Emerg Radiol ; 28(2): 339-347, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33420529

RESUMO

PURPOSE: To investigate the effect of the COVID-19 pandemic on emergency department (ED) imaging. METHODS: This retrospective study included all ED visits at a four-hospital academic health system in two matched 5-week periods. Demographic information, COVID-19 status, and disposition were reviewed. Type of imaging, acquisition time, and radiology reports were analyzed. Significance level was set at p < 0.05. RESULTS: A 43.2% decrease in ED visits and 12% reduction in overall ED imaging occurred during the pandemic period. Mean age was unchanged, but a shift in gender and racial characteristics was observed (p < 0.001). In the pandemic period, COVID-19 ED patients were older (61.8 ± 16.9 years, p < 0.001) and more likely to be Black (64.2%; p < 0.001) than non-COVID-19 patients. Imaging per ED encounter increased to 2.4 ± 2.8 exams from 1.7 ± 1.1 (p < 0.001). Radiography increased (57.2% vs. 52.4%) as a fraction of total ED imaging, while computed tomography (23.4% vs. 27.2%) and ultrasound (8.5% vs. 9.6%) decreased (pre-pandemic vs. pandemic). COVID-19 ED patients underwent CT and US at a lower rate (11.5% and 5.4%) than non-COVID-19 patients (25.4% and 9.1%). The proportion of imaging study reports concluding "no disease" or "no acute disease" decreased from 56.7 to 40.6% (p < 0.001). CONCLUSION: The COVID-19 pandemic led to a significant reduction in ED visits, a shift in patient demographics, and a significant decrease in imaging volume. Additional impact included a significant increase in the proportion of positive imaging studies.


Assuntos
/epidemiologia , Diagnóstico por Imagem/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Georgia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos
4.
JAMA Netw Open ; 4(1): e2033710, 2021 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-33512517

RESUMO

Importance: Diagnostic imaging is frequently performed as part of the emergency department (ED) evaluation of children. Whether imaging patterns differ by race and ethnicity is unknown. Objective: To evaluate racial and ethnic differences in the performance of common ED imaging studies and to examine patterns across diagnoses. Design, Setting, and Participants: This cross-sectional study evaluated visits by patients younger than 18 years to 44 US children's hospital EDs from January 1, 2016, through December 31, 2019. Exposures: Non-Hispanic Black and Hispanic compared with non-Hispanic White race/ethnicity. Main Outcomes and Measures: The primary outcome was the proportion of visits for each race/ethnicity group with at least 1 diagnostic imaging study, defined as plain radiography, computed tomography, ultrasonography, and magnetic resonance imaging. The major diagnostic categories classification system was used to examine race/ethnicity differences in imaging rates by diagnoses. Results: A total of 13 087 522 visits by 6 230 911 children and adolescents (mean [SD] age, 5.8 [5.2] years; 52.7% male) occurred during the study period. Diagnostic imaging was performed during 3 689 163 visits (28.2%). Imaging was performed in 33.5% of visits by non-Hispanic White patients compared with 24.1% of visits by non-Hispanic Black patients (odds ratio [OR], 0.60; 95% CI, 0.60-0.60) and 26.1% of visits by Hispanic patients (OR, 0.66; 95% CI, 0.66-0.67). Adjusting for confounders, visits by non-Hispanic Black (adjusted OR, 0.82; 95% CI, 0.82-0.83) and Hispanic (adjusted OR, 0.87; 95% CI, 0.87-0.87) patients were less likely to include any imaging study compared with visits by non-Hispanic White patients. Limiting the analysis to only visits by nonhospitalized patients, the adjusted OR for imaging was 0.79 (95% CI, 0.79-0.80) for visits by non-Hispanic Black patients and 0.84 (95% CI, 0.84-0.85) for visits by Hispanic patients. Results were consistent in analyses stratified by public and private insurance groups and did not materially differ by diagnostic category. Conclusions and Relevance: In this study, non-Hispanic Black and Hispanic children were less likely to receive diagnostic imaging during ED visits compared with non-Hispanic White children. Further investigation is needed to understand and mitigate these potential disparities in health care delivery and to evaluate the effect of these differential imaging patterns on patient outcomes.


Assuntos
Diagnóstico por Imagem/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Grupos Étnicos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hospitais Pediátricos , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estados Unidos
5.
AJR Am J Roentgenol ; 216(2): 519-525, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33356434

RESUMO

OBJECTIVE. The purpose of our study was to assess potential disparities in the utilization of advanced imaging during emergency department (ED) visits. MATERIALS AND METHODS. This retrospective study was conducting using 5% Research Identifiable Files. All CT and MRI (together defined as "advanced imaging") examinations associated with ED visits in 2015 were identified for continuously enrolled Medicare beneficiaries. Individuals with medical claims 30 days before the index ED event were excluded, and encounters that occurred in hospitals without advanced imaging capabilities were also excluded. Patient characteristics were identified using Medicare files and hospital characteristics using the American Hospital Association Annual Survey of Hospitals. Multivariate logistic regression was used for the analysis. RESULTS. Of 86,976 qualifying ED encounters, 52,833 (60.74%) ED encounters were for female patients; 29.03% (n = 25,245) occurred at rural hospitals and 15.81% (n = 13,750) at critical access hospitals. Race distribution was 83.13% White, 11.05% Black, and 5.82% Other. Compared with ED patients at urban hospitals, those at rural and critical access hospitals were 6.9% less likely (odds ratio [OR] = 0.931, p = 0.015) and 18.0% less likely (OR = 0.820, p < 0.0001), respectively, to undergo advanced imaging. Compared with White patients, Black patients were 31.6% less likely (OR = 0.684, p < 0.0001) to undergo advanced imaging. Relative to their urban counterparts, both White (OR = 0.941, p = 0.05) and Black (OR = 0.808, p = 0.047) rural ED patients were less likely to undergo advanced imaging. CONCLUSION. Among Medicare beneficiaries receiving care in U.S. EDs, significant disparities exist in advanced imaging utilization. Although imaging appropriateness was not investigated, these findings suggest inequity. Further research is necessary to understand why consistent health benefits do not translate into consistent imaging access among risk-adjusted ED patients.


Assuntos
Diagnóstico por Imagem/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Benefícios do Seguro , Medicare , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Modelos Logísticos , Masculino , Utilização de Procedimentos e Técnicas , Estudos Retrospectivos , Estados Unidos
6.
PLoS One ; 15(9): e0239059, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32936833

RESUMO

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.


Assuntos
Diagnóstico por Imagem/tendências , Serviço Hospitalar de Emergência/tendências , Hospitalização/tendências , Adulto , Idoso , Diagnóstico por Imagem/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Pesquisas sobre Serviços de Saúde , Hospitalização/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Medicare , Pessoa de Meia-Idade , Razão de Chances , Estados Unidos
7.
Emerg Radiol ; 27(6): 765-772, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32870462

RESUMO

PURPOSE: To illustrate the change in emergency department (ED) imaging utilization at a multicenter health system in the state of Ohio during the COVID-19 pandemic. METHODS: A retrospective observational study was conducted assessing ED imaging volumes between March 1, 2020, and May 11, 2020, during the COVID-19 crisis. A rolling 7-day total value was used for volume tracking and comparison. Total imaging utilization in the ED was compared with new COVID-19 cases in our region. Utilization was first categorized by modality and then by plain films and computed tomography (CT) scans grouped by body part. CT imaging of the chest was specifically investigated by assessing both CT chest only exams and CT chest, abdomen, and pelvis (C/A/P) exams. Ultimately, matching pair-wise statistical analysis of exam volumes was performed to assess significance of volume change. RESULTS: Our multicenter health system experienced a 46% drop in imaging utilization (p < 0.0001) during the pandemic. Matching pair-wise analysis showed a statistically significant volume decrease by each modality and body part. The exceptions were non-contrast chest CT, which increased (p = 0.0053), and non-trauma C/A/P CT, which did not show a statistically significant volume change (p = 0.0633). CONCLUSION: ED imaging utilization trends revealed through actual health system data will help inform evidence-based decisions for more accurate volume predictions and therefore institutional preparedness for current and future pandemics.


Assuntos
Infecções por Coronavirus/epidemiologia , Diagnóstico por Imagem/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Humanos , Ohio/epidemiologia , Pandemias , Estudos Retrospectivos , Revisão da Utilização de Recursos de Saúde
8.
Breast Cancer Res Treat ; 184(1): 249-254, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32772225

RESUMO

PURPOSE: The coronavirus disease (COVID-19) pandemic has had a profound impact on cancer care in the US Guidelines focused on the management of COVID-19, rather than healthcare needs of breast cancer patients requiring access to crucial services. This US survey of breast cancer survivors characterizes treatment delays early period in the pandemic. METHODS: We developed a survey and administered it to 609 adult breast cancer survivors in the US. We used snowball sampling with invitations distributed via social media. We used logistic regression to select a model of delay from a pool of independent variables including race, cancer stage, site of care, health insurance, and age. We used descriptive statistics to characterize delay types. RESULTS: Forty-four percent of participants reported cancer care treatment delays during the pandemic. Delays in all aspects of cancer care and treatment were reported. The only variable which had a significant effect was age (97 (.95, 99), p < 0.001) with younger respondents (M = 45.94, SD = 10.31) reporting a higher incidence of delays than older respondents (M = 48.98, SD = 11.10). There was no significant effect for race, insurance, site of care, or cancer stage. CONCLUSIONS: Our findings reveal a pervasive impact of COVID-19 on breast cancer care and a gap in disaster preparedness that leaves cancer survivors at risk for poor outcomes. Delays are critical to capture and characterize to help cancer providers and healthcare systems develop effective and patient-tailored processes and strategies to manage cases during the current pandemic wave, subsequent waves, and future disasters.


Assuntos
Neoplasias da Mama/terapia , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Tempo para o Tratamento/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Betacoronavirus , Neoplasias da Mama/diagnóstico por imagem , Assistência à Saúde , Diagnóstico por Imagem/estatística & dados numéricos , Feminino , Aconselhamento Genético/estatística & dados numéricos , Testes Genéticos/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Mamoplastia/estatística & dados numéricos , Mastectomia/estatística & dados numéricos , Pessoa de Meia-Idade , Ovariectomia/estatística & dados numéricos , Radioterapia/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos , Adulto Jovem
9.
Radiol Oncol ; 54(3): 329-334, 2020 07 29.
Artigo em Inglês | MEDLINE | ID: mdl-32726291

RESUMO

Background The COVID-19 pandemic has disrupted the provision and use of healthcare services throughout the world. In Slovenia, an epidemic was officially declared between mid-March and mid-May 2020. Although all non-essential health care services were put on hold by government decree, oncological services were listed as an exception. Nevertheless, as cancer control depends also on other health services and additionally major changes in people's behaviour likely occurred, we aimed to analyse whether cancer diagnosis and management were affected during the COVID-19 epidemic in Slovenia. Methods We analysed routine data for the period November 2019 through May 2020 from three sources: (1) from the Slovenian Cancer Registry we analysed data on pathohistological and clinical practice cancer notifications from two major cancer centres in Ljubljana and Maribor; (2) from the e-referral system we analysed data on all referrals in Slovenia issued for oncological services, stratified by type of referral; and (3) from the administrative data of the Institute of Oncology Ljubljana we analysed data on outpatient visits by type as well as on diagnostic imaging performed. Results Compared to the November 2019 - February 2020 average, the decrease in April 2020 was about 43% and 29% for pathohistological and clinical cancer notifications; 33%, 46% and 85% for first, control and genetic counselling referrals; 19% (53%), 43% (72%) and 20% (21%) for first (and control) outpatient visits at the radiotherapy, surgery and medical oncology sectors at the Institute of Oncology Ljubljana, and 48%, 76%, and 42% for X-rays, mammograms and ultrasounds performed at the Institute, respectively. The number of CT and MRI scans performed was not affected. Conclusions Significant drops in first referrals for oncological services, first visits and imaging studies performed at the Institute, as well as cancer notifications in April 2020 point to a possibility of a delayed cancer diagnosis for some patients during the first surge of SARS-CoV-2 cases in Slovenia. The reasons for the delay cannot be ascertained with certainty and could be linked to health-seeking behaviour of the patients, the beliefs and practices of doctors and/ or the health system management during the epidemic. Drops in control referrals and control visits were expected and are most likely due to the Institute of Oncology Ljubljana postponing non-essential follow-ups through May 2020.


Assuntos
Infecções por Coronavirus/epidemiologia , Neoplasias/diagnóstico , Neoplasias/terapia , Pandemias , Pneumonia Viral/epidemiologia , Assistência Ambulatorial/estatística & dados numéricos , Betacoronavirus , Institutos de Câncer/estatística & dados numéricos , Diagnóstico Tardio , Diagnóstico por Imagem/estatística & dados numéricos , Utilização de Instalações e Serviços , Acesso aos Serviços de Saúde , Humanos , Neoplasias/diagnóstico por imagem , Encaminhamento e Consulta/estatística & dados numéricos , Sistema de Registros , Eslovênia/epidemiologia
10.
J Am Coll Radiol ; 17(9): 1086-1095, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32717183

RESUMO

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic resulted in significant loss of radiologic volume as a result of shelter-at-home mandates and delay of non-time-sensitive imaging studies to preserve capacity for the pandemic. We analyze the volume-related impact of the COVID-19 pandemic on six academic medical systems (AMSs), three in high COVID-19 surge (high-surge) and three in low COVID-19 surge (low-surge) regions, and a large national private practice coalition. We sought to assess adaptations, risks of actions, and lessons learned. METHODS: Percent change of 2020 volume per week was compared with the corresponding 2019 volume calculated for each of the 14 imaging modalities and overall total, outpatient, emergency, and inpatient studies in high-surge AMSs and low-surge AMSs and the practice coalition. RESULTS: Steep examination volume drops occurred during week 11, with slow recovery starting week 17. The lowest total AMS volume drop was 40% compared with the same period the previous year, and the largest was 70%. The greatest decreases were seen with screening mammography and dual-energy x-ray absorptiometry scans, and the smallest decreases were seen with PET/CT, x-ray, and interventional radiology. Inpatient volume was least impacted compared with outpatient or emergency imaging. CONCLUSION: Large percentage drops in volume were seen from weeks 11 through 17, were seen with screening studies, and were larger for the high-surge AMSs than for the low-surge AMSs. The lowest drops in volume were seen with modalities in which delays in imaging had greater perceived adverse consequences.


Assuntos
Infecções por Coronavirus/prevenção & controle , Diagnóstico por Imagem/estatística & dados numéricos , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/estatística & dados numéricos , Radiologia/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Diagnóstico por Imagem/métodos , Feminino , Previsões , Humanos , Incidência , Aprendizagem , Masculino , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Radiologia/tendências , Medição de Risco , Estados Unidos
11.
Aging Clin Exp Res ; 32(9): 1889-1895, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32638344

RESUMO

BACKGROUND: The potential differences between a clinical diagnosis of coronavirus disease 2019 (COVID-19) (i.e., symptoms without positive virus test) and a microbiological diagnosis (i.e., positive virus test results) of COVID-19 are not known. AIMS: This study explored the differences between the two types of COVID-19 diagnosis among older patients in terms of clinical characteristics and outcomes. METHODS: A total of 244 inpatients aged ≥ 60 years with COVID-19 were included in this study, of whom 52 were clinically diagnosed and 192 were microbiologically diagnosed. Clinical and laboratory data on hospital admission and outcomes (discharged or died in hospital) of all patients were retrieved from medical records retrospectively. Patients who met the criteria for clinical diagnosis with negative virus test results were assigned to the clinical diagnosis group, whereas those with positive virus test results were assigned to the microbiological diagnosis group. After univariate analyses, two propensity score analyses [i.e., covariate adjustment using propensity score (CAPS) and propensity score matching (PSM)] were conducted to control bias. RESULTS: The clinical and microbiological diagnosis groups demonstrated significant differences in outcomes and in the majority of laboratory findings. After propensity score analyses, many differences between the two groups disappeared and the rate of mortality had no statistically significant difference (P = 0.318 and 0.828 for CAPS and PSM, respectively). CONCLUSIONS: Patients with similar signs, symptoms, and laboratory and imaging findings as confirmed COVID-19 cases may have a similar mortality risk, regardless of the virus test results, and require timely intervention to reduce their mortality.


Assuntos
Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico , Infecções por Coronavirus , Diagnóstico por Imagem , Pandemias , Pneumonia Viral , Avaliação de Sintomas , Idoso , China/epidemiologia , Técnicas de Laboratório Clínico/métodos , Técnicas de Laboratório Clínico/estatística & dados numéricos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Correlação de Dados , Diagnóstico por Imagem/métodos , Diagnóstico por Imagem/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Estudos Retrospectivos , Medição de Risco , Avaliação de Sintomas/métodos , Avaliação de Sintomas/estatística & dados numéricos
12.
Eur Respir J ; 56(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32616598
13.
J Am Coll Radiol ; 17(10): 1289-1298, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32622817

RESUMO

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on imaging utilization across practice settings. The purpose of this study was to quantify the change in the composition of inpatient imaging volumes for modality types and Current Procedural Terminology-coded groups during the COVID-19 pandemic. METHODS: A retrospective study of inpatient imaging volumes in a large health care system was performed, analyzing weekly imaging volumes by modality types (radiography, CT, MRI, ultrasound, interventional radiology, nuclear medicine) in years 2020 and 2019. The data set was split to compare pre-COVID-19 (weeks 1-9) and post-COVID-19 (weeks 10-16) periods. Further subanalyses compared early post-COVID-19 (weeks 10-13) and late post-COVID-19 (weeks 14-16) periods. Statistical comparisons were performed using χ2 and independent-samples t tests. RESULTS: Compared with 2019, total inpatient imaging volume in 2020 post-COVID-19, early and late post-COVID-19 periods, declined by 13.6% (from 78,902 to 68,168), 16.6% (from 45,221 to 37,732), and 9.6% (from 33,681 to 30,436), respectively. By week 16, inpatient imaging volume rebounded and was only down 4.2% (from 11,003 to 10,546). However, a statistically significant shift (P < .0001) in the 2020 composition mix was observed largely comprised of radiography (74.3%), followed by CT (12.7%), ultrasound (8%), MRI (2.4%), interventional radiology (2.3%), and nuclear medicine (0.4%). Although the vast majority of imaging studies declined, few Current Procedural Terminology-coded groups showed increased trends in imaging volumes in the late post-COVID-19 period, including CT angiography chest, radiography chest, and ultrasound venous duplex. DISCUSSION: During the COVID-19 pandemic, we observed a decrease in inpatient imaging volumes accompanied by a shift away from cross-sectional imaging toward radiography. These findings could have significant implications in planning for a potential resurgence.


Assuntos
Infecções por Coronavirus/prevenção & controle , Diagnóstico por Imagem/métodos , Diagnóstico por Imagem/estatística & dados numéricos , Controle de Infecções/métodos , Pacientes Internados/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Serviço Hospitalar de Radiologia/estatística & dados numéricos , Angiografia por Tomografia Computadorizada/métodos , Angiografia por Tomografia Computadorizada/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Bases de Dados Factuais , Feminino , Humanos , Angiografia por Ressonância Magnética/métodos , Angiografia por Ressonância Magnética/estatística & dados numéricos , Imagem por Ressonância Magnética/métodos , Imagem por Ressonância Magnética/estatística & dados numéricos , Masculino , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Prevalência , Valores de Referência , Estudos Retrospectivos , Medição de Risco , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Estados Unidos
14.
Emerg Radiol ; 27(6): 781-784, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32504280

RESUMO

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic has led to significant disruptions in the healthcare system including surges of infected patients exceeding local capacity, closures of primary care offices, and delays of non-emergent medical care. Government-initiated measures to decrease healthcare utilization (i.e., "flattening the curve") have included shelter-in-place mandates and social distancing, which have taken effect across most of the USA. We evaluate the immediate impact of the Public Health Messaging and shelter-in-place mandates on Emergency Department (ED) demand for radiology services. METHODS: We analyzed ED radiology volumes from the five University of California health systems during a 2-week time period following the shelter-in-place mandate and compared those volumes with March 2019 and early April 2019 volumes. RESULTS: ED radiology volumes declined from the 2019 baseline by 32 to 40% (p < 0.001) across the five health systems with a total decrease in volumes across all 5 systems by 35% (p < 0.001). Stratifying by subspecialty, the smallest declines were seen in non-trauma thoracic imaging, which decreased 18% (p value < 0.001), while all other non-trauma studies decreased by 48% (p < 0.001). CONCLUSION: Total ED radiology demand may be a marker for public adherence to shelter-in-place mandates, though ED chest radiology demand may increase with an increase in COVID-19 cases.


Assuntos
Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/epidemiologia , Diagnóstico por Imagem/estatística & dados numéricos , Serviço Hospitalar de Emergência , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/epidemiologia , Betacoronavirus , California/epidemiologia , Feminino , Humanos , Masculino , Pandemias , Quarentena , Revisão da Utilização de Recursos de Saúde
15.
Diagn Interv Radiol ; 26(4): 301-307, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32436847

RESUMO

PURPOSE: We aimed to retrospectively analyze the imaging changes detected in the follow-up of coronavirus disease 2019 (COVID-19) patients on thin-section computed tomography (CT). METHODS: We included 54 patients diagnosed with COVID-19. The mean interval between the initial and follow-up CT scans was 7.82±3.74 days. Patients were divided into progression and recovery groups according to their outcomes. We evaluated CT images in terms of distribution of lesions and imaging manifestations. The manifestations included ground-glass opacity (GGO), crazy-paving pattern, consolidation, irregular line, and air bronchogram sign. RESULTS: COVID-19 lesions showed mainly subpleural distribution, which was accompanied by bronchovascular bundle distribution in nearly 30% of the patients. The lower lobes of both lungs were the most commonly involved. In the follow-up, the progression group showed more involvement of the upper lobe of the left lung than the recovery group. GGO was the most common sign. As the disease progressed, round GGO decreased and patchy GGO increased. On follow-up CT, consolidation increased in the progression group while decreasing in the recovery group. Air bronchogram sign was more commonly observed at the initial examination (90.9%) than at follow-up (30%) in the recovery group, but there was no significant change in the progression group. Pleural effusion and lymphadenopathy were absent in the initial examination, but pleural effusion was observed in three cases after follow-up. CONCLUSION: As COVID-19 progressed, round GGOs tended to evolve into patchy GGOs, consolidation increased, and pleural effusion could be occasionally observed. As COVID-19 resolved, the crazy-paving pattern and air bronchogram significantly decreased.


Assuntos
Infecções por Coronavirus/diagnóstico por imagem , Diagnóstico por Imagem/estatística & dados numéricos , Pulmão/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adulto , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Diagnóstico por Imagem/tendências , Progressão da Doença , Feminino , Seguimentos , Humanos , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Pandemias , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/epidemiologia , Derrame Pleural/patologia , Pneumonia/diagnóstico por imagem , Pneumonia/patologia , Pneumonia/virologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
16.
AJR Am J Roentgenol ; 215(2): 420-424, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32452692

RESUMO

OBJECTIVE. The purpose of this study was to analyze recent trends in abdominal imaging utilization in the Medicare population. MATERIALS AND METHODS. Medicare Part B databases for 2004-2016 were reviewed, and all Current Procedural Terminology codes pertaining to noninvasive imaging of the abdomen and pelvis were identified. Codes were grouped into six categories: CT and CT angiography (CTA), MRI and MR angiography (MRA), ultrasound, radionuclide imaging, radiography, and gastrointestinal fluoroscopy. Annual utilization rates per 1000 Medicare beneficiaries were calculated. Medicare physician specialty codes were used to identify studies performed by radiologists versus nonradiologist physicians. Reimbursements were determined. RESULTS. Total abdominal imaging utilization decreased from 558.0 examinations per 1000 Medicare beneficiaries in 2004 to 441.9 in 2016 (-20.8%). CT and CTA examinations increased by 22.5% from 2004 to 2010, followed by a sharp drop in 2011 caused by code bundling. From 2011 to 2016, CT and CTA use increased by only 7.2%. Radiography utilization decreased from 129.6 examinations per 1000 Medicare beneficiaries in 2004 to 91.5 in 2016 (-29.4%). Radionuclide studies decreased from 14.0 to 9.5 (-32.1%), and gastrointestinal fluoroscopy decreased from 37.8 examinations to 22.5 (-40.5%). Utilization of ultrasound increased slightly (1.5%), whereas MRI and MRA utilization sharply increased on a percentage basis (81.2%). Reimbursements peaked in 2009 at $1.704 billion, dropped substantially in 2011 because of code bundling, and remained relatively stable thereafter. The radiologists' market share of abdominal imaging was approximately 87% in both 2004 and 2016. CONCLUSION. Abdominal imaging utilization rates have declined in recent years, in part due to code bundling, but also largely because of a decrease in the use of abdominal radiography, gastrointestinal fluoroscopy, and nuclear imaging. Reimbursements have also declined. This study also showed that most of the abdominal imaging was performed by radiologists.


Assuntos
Abdome/diagnóstico por imagem , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Diagnóstico por Imagem/estatística & dados numéricos , Humanos , Medicare Part B , Fatores de Tempo , Estados Unidos
17.
Eur J Radiol ; 125: 108864, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32062329

RESUMO

PURPOSE: To assess compliance of lumbar spine imaging referrals with national imaging recommendations and to evaluate the impact of inappropriate imaging on the collective radiation dose and health insurance costs. METHOD: In 2011 and 2015, 633 lumbar spine imaging referrals were evaluated across 9 Belgian hospitals. For each patient, a new clinical anamnesis and physical examination were performed. Together with the referral, this data were confronted with the national imaging recommendations. Collective radiation dose was estimated for the radiography and CT procedures. Cost analysis was based on national reimbursement fees. Statistical analysis was performed using multilevel linear and logistic regression models. RESULTS: The fraction of unjustified imaging referrals decreased from 50 % in 2011 to 41 % in 2015 (p = 0.255). The odds of a justified examination are 3.1 times higher when the referral is done by a specialist instead of a general practitioner. The highest percentage of unjustified examinations was found for CT (85 % in 2011, 81 % in 2015; p = 0.044). Seventy-five percent of the collective dose of both the 2011 and the 2015 study population was not justified. Adherence to the recommendations could result in an estimated 16 % and 5 % cost reduction for the 2011 and 2015 study samples, respectively. CONCLUSIONS: Between 2011 and 2015, no significant improvement was found in requesting justified lumbar spine imaging procedures, although a positive trend was observed for CT. A shift from CT to MRI is necessary to improve the appropriateness of lumbar spine imaging referrals and to reduce the collective radiation dose.


Assuntos
Diagnóstico por Imagem/economia , Diagnóstico por Imagem/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Vértebras Lombares/diagnóstico por imagem , Doses de Radiação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bélgica , Análise Custo-Benefício/economia , Análise Custo-Benefício/métodos , Análise Custo-Benefício/estatística & dados numéricos , Diagnóstico por Imagem/métodos , Feminino , Fidelidade a Diretrizes/economia , Humanos , Imagem por Ressonância Magnética/economia , Imagem por Ressonância Magnética/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Radiografia/economia , Radiografia/estatística & dados numéricos , Encaminhamento e Consulta/economia , Encaminhamento e Consulta/estatística & dados numéricos , Tomografia Computadorizada por Raios X/economia , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adulto Jovem
18.
BMJ Open Qual ; 9(1)2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32019751

RESUMO

Over 90% of patients with head trauma seen in emergency departments (EDs) are diagnosed with minor head injuries. Over-utilisation of CT scans results in unnecessary exposure to radiation and increases healthcare utilisation. Using recommendations from the Choosing Wisely Canada (CWC) campaign and quality improvement (QI) methodology, we aimed to reduce the CT scan rate for head injuries by 10% over a 6-month period.Baseline CT scan rates were determined through a 27-month retrospective cohort review. We used stakeholder engagement and provider surveys to develop our driver diagram and Plan-Do-Study-Act (PDSA) cycles, which included (1) improving provider knowledge about the CWC campaign recommendations; (2) testing, refining and implementing a modified Canadian CT Head Rule checklist; (3) developing CWC-themed head injury-specific patient handouts; and (4) feedback on CT scan group ordering rates to providers. Our primary outcome measure was the number of CT scans performed for patients with head injuries. Process measures included the number of checklists completed and ED length of stay (LOS). Our balancing measure was return ED visits within 72 hours (with or without admission).Baseline CT scan rates prior to our interventions was 46.1%. Our QI initiative resulted in a 'shift' in the Statistical Process Control chart of the weekly CT scan rates, associated with the first and second PDSA cycles, resulting in a 13.9% reduction in CT rates during the initial 3 months, and a sustained reduction of 8% at 16 months (p<0.05). Mean ED LOS for all patients with head injuries decreased by 1.5 min (p=0.74). 33% of checklists were completed. 72-hour return visits did not change significantly (p=0.68).Through provider and patient education, and the creation of a user-friendly evidence-based tool, our local QI initiative was successful in achieving long-term reduction in CT rates for patients presenting to EDs with head injuries.


Assuntos
Traumatismos Craniocerebrais/terapia , Diagnóstico por Imagem/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Melhoria de Qualidade , Lista de Checagem/métodos , Lista de Checagem/normas , Lista de Checagem/estatística & dados numéricos , Traumatismos Craniocerebrais/fisiopatologia , Diagnóstico por Imagem/normas , Gerenciamento Clínico , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Ontário , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/estatística & dados numéricos
19.
Bull Cancer ; 107(2): 181-190, 2020 Feb.
Artigo em Francês | MEDLINE | ID: mdl-32005357

RESUMO

The Paul Strauss Center day-care accompaniment department ("SSAJ") is an oncologic supportive day-care, also an alternative to conventional hospitalization. In order to follow the SSAJ department's activity, in the "ambulatory turnover" context, we compared the 2008 and 2016 four first months activity. In 2016, there was an average of 4.96 patients per day versus 5.62 in 2008 (P<0.001); average day incoming of 653€ per stay in 2016 versus 775€ in 2008 (P<0.001). In 2016, there was an average 63.9 % of imagery done versus 27.7 % in 2008 (P<0.001). The 2016 average patient following period was of 84.7 days versus 67.6 days in 2008 (P=0.019). Average time between first day-care visit and death was 161.7 days in 2016 versus 133.5 days in 2008 (P=0.0033). Average day activity is lower in 2016 than 2008, nonetheless number of total stays and inpatients has increased on the four months period. The SSAJ intervenes more precociously in 2016 than 2008. Hospital technical platform is better used, but average per-stay incoming has statistically lowered. The SSAJ limits and prepares complete hospitalizations. Inpatient close reevaluation after a "shorter-willing" stay, home issues anticipation and identification with the home-care team, and worsening prevention gives this activity all its meaning.


Assuntos
Institutos de Câncer/estatística & dados numéricos , Hospital Dia/estatística & dados numéricos , Neoplasias/terapia , Idoso , Antineoplásicos/uso terapêutico , Hospital Dia/economia , Diagnóstico por Imagem/estatística & dados numéricos , França , Humanos , Pessoa de Meia-Idade , Neoplasias/diagnóstico por imagem , Alta do Paciente/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos
20.
Can J Surg ; 63(2): E100-E109, 2020 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-32109016

RESUMO

Background: In 2012, the American Society of Clinical Oncology (ASCO) released a Choosing Wisely Top Five list that included a recommendation against ordering advanced imaging tests to screen for metastases among asymptomatic patients with early breast cancer. Our provincial breast cancer staging guideline was subsequently updated. We report on the use of unwarranted bone scanning (BS), computed tomography (CT), nonbreast magnetic resonance imaging (MRI) and positron emission tomography (PET) among women diagnosed with stage 0­II breast cancer in Alberta in 2011­2015. Methods: The cohort was retrospectively ascertained from the Alberta Cancer Registry. We used additional provincial data sources to obtain information about diagnostic imaging tests completed from biopsy to surgical date plus 4 months. The reason for each BS, CT, MRI and PET was abstracted. We calculated the frequency of advanced imaging tests completed for routine metastatic screening. Results: Of 10 142 patients included, 2887 (28.5%) had at least 1 advanced imaging test completed for routine metastatic screening. Of these 2887 patients, 438 (15.2%) had a follow-up BS, CT, MRI or PET, and 28 patients (1.0%) had a nonbreast imageguided biopsy. Use of routine advanced imaging tests did not change clearly over time. Conclusion: Our results demonstrate persistent use of advanced imaging tests for routine metastatic screening among patients with stage 0­II breast cancer despite the release of the ASCO Choosing Wisely recommendations and the update of our provincial breast cancer staging guideline. Investigation of strategies for guideline translation to improve upon value-based care of patients with early breast cancer is warranted.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Diagnóstico por Imagem/estatística & dados numéricos , Metástase Neoplásica/diagnóstico por imagem , Procedimentos Desnecessários/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Alberta/epidemiologia , Osso e Ossos/diagnóstico por imagem , Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/patologia , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Sistema de Registros , Estudos Retrospectivos , Adulto Jovem
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