BACKGROUND Abdominal pain is associated with high rates of emergency department (ED) imaging utilization and revisits. While imaging often improves diagnosis, a better understanding is needed on when the decision to image is justified and how it influences subsequent resource utilization and outcomes for patients in the ED presenting with abdominal pain. We evaluated the association between advanced ED imaging on subsequent outpatient imaging and on revisits among abdominal pain patients discharged from the ED. METHODS A retrospective, observational study was conducted using electronic health record data from an academic ED in the U.S. Midwest. A sample of Medicare patients with a chief complaint of abdominal pain from January 2013 to December 2016 following ED evaluation were included in the analysis. Logistic regression was used to estimate associations between receiving advanced imaging in the ED and subsequent outpatient imaging within 7-, 14-, and 28-day windows after discharge, and 30-day revisit rates to the study ED and to any ED. RESULTS Of the 1385 ED visits with abdominal pain chief complaint and discharged home from the ED, individuals who were not imaged in the ED had significantly higher adjusted odds of being imaged outside the ED within 7 days (adjusted odds ratio [aOR] 6.65, 95% confidence interval [CI] 3.96-11.17, p < 0.001), 14 days (aOR 4.69, 95% CI 3.11-7.07, p < 0.001), and 28 days (aOR 3.1, 95% CI 2.25-4.27, p < 0.001) of being discharged and had a significantly higher adjusted odds of revisiting the study ED (aOR 1.65, 95% CI 1.29-2.12, p < 0.001) and revisiting any ED (aOR 1.47, 95% CI 1.16-1.86, p = 0.001) within 30 days of being discharged. CONCLUSIONS Abdominal imaging in the ED was associated with significantly lower imaging utilization after discharge and 30-day revisit rates, suggesting that imaging in the ED may replace downstream outpatient imaging.

中文翻译：

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急诊室订购的高级图像与腹痛患者后续成像之间的关联。

背景技术腹痛与急诊科 (ED) 影像利用率高和复诊率高有关。虽然成像通常可以改善诊断，但需要更好地了解何时进行成像的决定是合理的，以及它如何影响 ED 中出现腹痛的患者的后续资源利用和结果。我们评估了先进的 ED 成像与随后的门诊成像与从 ED 出院的腹痛患者再次就诊之间的关联。方法 使用来自美国中西部学术急诊部的电子健康记录数据进行了一项回顾性观察性研究。2013 年 1 月至 2016 年 12 月在 ED 评估后主诉腹痛的 Medicare 患者样本被纳入分析。逻辑回归用于估计在 ED 中接受高级成像与出院后 7、14 和 28 天窗口内的后续门诊成像之间的关联，以及对研究 ED 和任何 ED 的 30 天再访率。结果 在以腹痛为主诉并从急诊室出院回家的 1385 次急诊就诊中，未在急诊室接受成像的个体在 7 天内在急诊室外接受成像的调整几率显着更高（调整优势比 [aOR] 6.65, 95 % 置信区间 [CI] 3.96-11.17，p < 0.001），14 天（aOR 4.69，95% CI 3.11-7.07，p < 0.001）和 28 天（aOR 3.1，95% CI 2.25-4.27，p < 0.001 ) 出院后再次访问研究 ED (aOR 1.65, 95% CI 1.29-2.12, p < 0.001) 和重新访问任何 ED (aOR 1.47, 95% CI 1.16-1.86, p = 0. 001) 出院后 30 天内。结论 ED 中的腹部成像与出院后成像利用率和 30 天再访率显着降低相关，这表明 ED 中的成像可以取代下游门诊成像。