Advanced diagnostic imaging utilization during emergency department visits in the United States: A predictive modeling study for emergency department triage.

Xingyu Zhang,Justin D Schrager,Falgun H Chokshi,Stephen R Pitts,Rachel E Patzer,Joyce Kim,Dongmei Li

doi:10.1371/journal.pone.0214905

Abstract

BackgroundEmergency department (ED) crowding is associated with negative health outcomes, patient dissatisfaction, and longer length of stay (LOS). The addition of advanced diagnostic imaging (ADI), namely CT, ultrasound (U/S), and MRI to ED encounter work up is a predictor of longer length of stay. Earlier and improved prediction of patients’ need for advanced imaging may improve overall ED efficiency. The aim of the study was to detect the association between ADI utilization and the structured and unstructured information immediately available during ED triage, and to develop and validate models to predict utilization of ADI during an ED encounter.MethodsWe used the United States National Hospital Ambulatory Medical Care Survey data from 2009 to 2014 to examine which sociodemographic and clinical factors immediately available at ED triage were associated with the utilization of CT, U/S, MRI, and multiple ADI during a patient’s ED stay. We used natural language processing (NLP) topic modeling to incorporate free-text reason for visit data available at time of ED triage in addition to other structured patient data to predict the use of ADI using multivariable logistic regression models.ResultsAmong the 139,150 adult ED visits from a national probability sample of hospitals across the U.S, 21.9% resulted in ADI use, including 16.8% who had a CT, 3.6% who had an ultrasound, 0.4% who had an MRI, and 1.2% of the population who had multiple types of ADI. The c-statistic of the predictive models was greater than or equal to 0.78 for all imaging outcomes, and the addition of text-based reason for visit information improved the accuracy of all predictive models.ConclusionsPatient information immediately available during ED triage can accurately predict the eventual use of advanced diagnostic imaging during an ED visit. Such models have the potential to be incorporated into the ED triage workflow in order to more rapidly identify patients who may require advanced imaging during their ED stay and assist with medical decision-making.

Highlights

Emergency department (ED) crowding is a well-recognized problem in the United States [1,2,3]
Among the 139,150 adult ED visits from a national probability sample of hospitals across the U.S, 21.9% resulted in advanced diagnostic imaging (ADI) use, including 16.8% who had a computed tomography (CT), 3.6% who had an ultrasound, 0.4% who had an magnetic resonance imaging (MRI), and 1.2% of the population who had multiple types of ADI
Patient information immediately available during ED triage can accurately predict the eventual use of advanced diagnostic imaging during an ED visit

Summary

Introduction

Research has not examined the role of a predictive model that can use information immediately available to a triage provider upon patient arrival (e.g. patient demographics, vitals, medical history, and the patient’s own descriptions of their reason for visit) to estimate the probability that the patient will undergo ADI during their ED visit. Such a predictive model—if implemented and tested in the clinical setting perhaps as an adjunct to the Electronic Health Record (EHR) or as a standalone program—could support clinicians in making rapid, informed decisions regarding ADI. The aim of the study was to detect the association between ADI utilization and the structured and unstructured information immediately available during ED triage, and to develop and validate models to predict utilization of ADI during an ED encounter

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