Abstract
This study describes the protocol for a systematic review and meta-analysis. The primary objective of the review is to identify experimental studies assessing the effectiveness of interventions that aim to reduce the proportion of computed tomography (CT) in emergency departments (EDs). Data permitting, our secondary objectives will be to assess the impact of reduction in CT utilization on the length of stay, admission to hospital, and uptake/satisfaction with the intervention. When available, balancing measures such as readmission to hospital or ED revisit rates will be included. Pre-defined subgroup analyses include patient populations (adult or pediatric), type of ED, and the nature of the intervention.Through this review, the research team aims to inform knowledge translation initiatives aimed at lowering CT usage in the ED by identifying the most effective interventions to safely improve CT resource stewardship.
Highlights
Description of the issueComputed tomography (CT) is an important diagnostic tool used in the assessment of patients in the Emergency Department (ED)
Each title and abstract will be screened by two independent reviewers to identify potential articles and remove any duplicates
A full text review of applicable studies will be conducted by two independent reviewers who will apply the eligibility criteria to each study using a standardized form
Summary
Computed tomography (CT) is an important diagnostic tool used in the assessment of patients in the Emergency Department (ED). While CT is an important diagnostic imaging modality, it is associated with radiation exposure, increased health system costs, longer ED lengths of stay, and impaired flow of patients through the department [3]. Data suggests that national CT utilization for ED patients is increasing at rates exceeding the increase in patient volumes. Some of these CTs are likely avoidable. If the increasing use of CT was associated with improved patient-oriented outcomes, the risks may be worth the benefits but that is not always the case. The use of CT pulmonary angiograms to diagnose pulmonary emboli (PE) has been steadily rising but the rates of massive PEs and the mortality rate due to them have been on the decline [5,6,7]
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