Evidence map›Paper›PMID 38400982›Full record

ArticleAbdominal radiology (New York)2024

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

Sonia Gaur, Jonathan P Troost, Christopher M Fung, Joshua Breeden, Daniel Barkmeier, Prasad R Shankar, Shokoufeh Khalatbari, Matthew S Davenport

Abstract read
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Article in Abdominal radiology (New York), 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

What it found

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2 · The registry

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3 · Its place in the literature

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0 citing papers in PubMed, 0 citations in OpenAlex.

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4 · The record

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5 · Who and what money

Authors and funding

8 authors at 2 institutions in 1 country.

Sonia GaurDepartment of Radiology, University of Michigan, Ann Arbor, MI, USA. gaurssonia@gmail.com.ORCID 0000-0001-9497-5412
Jonathan P TroostMichigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA.
Christopher M FungDepartment of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA.
Joshua BreedenDepartment of Radiology, University of Michigan, Ann Arbor, MI, USA.
Daniel BarkmeierDepartment of Radiology, University of Michigan, Ann Arbor, MI, USA.
Prasad R ShankarDepartment of Radiology, University of Michigan, Ann Arbor, MI, USA.
Shokoufeh KhalatbariMichigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA.
Matthew S DavenportDepartment of Radiology, University of Michigan, Ann Arbor, MI, USA.
University of Michigan · USCleveland Clinic · US

Funding

Michigan Institute for Clinical and Health Research (MICHR)UL1TR002240 · NCATS · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI LUMENG, JULIE C, MASHOUR, GEORGE ALEXANDER · 2017 to 2022
$54.9M
NCATS NIH HHS UL1TR002240
6 · The paper itself

Abstract

purposeRadiologists 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.

methodsConsecutive 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).

resultsThe 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 < 0.001) although this difference was small and imprecise. HIDA was mentioned variably by radiologists (range 0-19%, p < 0.001), and mention of HIDA in the ultrasound report increased 10-fold the odds of HIDA being performed in the next 72 h (odds ratio 10.4 [8.0-13.4], p < 0.001).

conclusionRadiologist variability did not predict meaningful outcome differences for patients with right upper quadrant pain undergoing ultrasound in the Emergency Department, but when radiologists mention HIDA in their reports, it predicts a 10-fold increase in the odds a HIDA is performed. Radiologists are relied on for interpretation that shapes subsequent patient care, and it is important to consider how radiologist variability can influence both outcome and resource utilization.

Indexed as

Abdominal PainEmergency Service, HospitalRadiologistsUltrasonographyAdultAgedFemaleHumansLength of StayMaleMiddle AgedRetrospective StudiesAbdominal painHealthcare qualityHIDAPatient outcomesResource allocationUltrasound

Identifiers

PMID38400982
OpenAlexW4392132387

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.