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CT in the Emergency Department: A Real-Time Study of Changes in Physician Decision Making.

Publication ,  Journal Article
Pandharipande, PV; Reisner, AT; Binder, WD; Zaheer, A; Gunn, ML; Linnau, KF; Miller, CM; Avery, LL; Herring, MS; Tramontano, AC; Dowling, EC ...
Published in: Radiology
March 2016

PURPOSE: To determine how physicians' diagnoses, diagnostic uncertainty, and management decisions are affected by the results of computed tomography (CT) in emergency department settings. MATERIALS AND METHODS: This study was approved by the institutional review board and compliant with HIPAA. Data were collected between July 12, 2012, and January 13, 2014. The requirement to obtain patient consent was waived. In this prospective, four-center study, patients presenting to the emergency department who were referred for CT with abdominal pain, chest pain and/or dyspnea, or headache were identified. Physicians were surveyed before and after CT to determine the leading diagnosis, diagnostic confidence (on a scale of 0% to 100%), alternative "rule out" diagnosis, and management decisions. Primary measures were the proportion of patients for whom the leading diagnosis or admission decision changed and median changes in diagnostic confidence. Secondary measures addressed alternative diagnoses and return-to-care visits (eg, to emergency department) at 1-month follow-up. Regression analysis was used to identify associations between primary measures and site and participant characteristics. RESULTS: Both surveys were completed for 1280 patients by 245 physicians. The leading diagnosis changed in 235 of 460 patients with abdominal pain (51%), 163 of 387 with chest pain and/or dyspnea (42%), and 103 of 433 with headache (24%). Pre-CT diagnostic confidence was inversely associated with the likelihood of a diagnostic change (P < .0001). Median changes in confidence were substantial (increases of 25%, 20%, and 13%, respectively, for patients with abdominal pain, chest pain and/or dyspnea, and headache; P < .0001); median post-CT confidence was high (95% for all three groups). CT helped confirm or exclude at least 95% of alternative diagnoses. Admission decisions changed in 116 of 457 patients with abdominal pain (25%), 72 of 387 with chest pain and/or dyspnea (19%), and 81 of 426 with headache (19%). During follow-up, 70 of 450 patients with abdominal pain (15%), 53 of 387 with chest pain and/or dyspnea (14%), and 49 of 433 with headache (11%) returned for the same indication. In general, changes in leading diagnosis, diagnostic confidence, and admission decisions were not well explained with site or participant characteristics. CONCLUSION: Physicians' diagnoses and admission decisions changed frequently after CT, and diagnostic uncertainty was alleviated.

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Published In

Radiology

DOI

EISSN

1527-1315

Publication Date

March 2016

Volume

278

Issue

3

Start / End Page

812 / 821

Location

United States

Related Subject Headings

  • United States
  • Tomography, X-Ray Computed
  • Prospective Studies
  • Practice Patterns, Physicians'
  • Nuclear Medicine & Medical Imaging
  • Middle Aged
  • Male
  • Humans
  • Female
  • Emergency Service, Hospital
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Pandharipande, P. V., Reisner, A. T., Binder, W. D., Zaheer, A., Gunn, M. L., Linnau, K. F., … Gazelle, G. S. (2016). CT in the Emergency Department: A Real-Time Study of Changes in Physician Decision Making. Radiology, 278(3), 812–821. https://doi.org/10.1148/radiol.2015150473
Pandharipande, Pari V., Andrew T. Reisner, William D. Binder, Atif Zaheer, Martin L. Gunn, Ken F. Linnau, Chad M. Miller, et al. “CT in the Emergency Department: A Real-Time Study of Changes in Physician Decision Making.Radiology 278, no. 3 (March 2016): 812–21. https://doi.org/10.1148/radiol.2015150473.
Pandharipande PV, Reisner AT, Binder WD, Zaheer A, Gunn ML, Linnau KF, et al. CT in the Emergency Department: A Real-Time Study of Changes in Physician Decision Making. Radiology. 2016 Mar;278(3):812–21.
Pandharipande, Pari V., et al. “CT in the Emergency Department: A Real-Time Study of Changes in Physician Decision Making.Radiology, vol. 278, no. 3, Mar. 2016, pp. 812–21. Pubmed, doi:10.1148/radiol.2015150473.
Pandharipande PV, Reisner AT, Binder WD, Zaheer A, Gunn ML, Linnau KF, Miller CM, Avery LL, Herring MS, Tramontano AC, Dowling EC, Abujudeh HH, Eisenberg JD, Halpern EF, Donelan K, Gazelle GS. CT in the Emergency Department: A Real-Time Study of Changes in Physician Decision Making. Radiology. 2016 Mar;278(3):812–821.

Published In

Radiology

DOI

EISSN

1527-1315

Publication Date

March 2016

Volume

278

Issue

3

Start / End Page

812 / 821

Location

United States

Related Subject Headings

  • United States
  • Tomography, X-Ray Computed
  • Prospective Studies
  • Practice Patterns, Physicians'
  • Nuclear Medicine & Medical Imaging
  • Middle Aged
  • Male
  • Humans
  • Female
  • Emergency Service, Hospital