The association between advanced diagnostic imaging and ED length of stay - 04/10/14
, Marc A. Probst, MD b, Ninez A. Ponce, PhD c, Renee Y. Hsia, MD dAbstract |
Objective |
There has been a rise in advanced diagnostic imaging (ADI) use in the emergency department (ED). Increased utilization may contribute to longer length of stay (LOS), but prior reports have not considered improved methods for modeling skewed LOS data.
Methods |
The 2010 National Hospital Ambulatory Medical Care Survey data were analyzed by 5 common ED chief complaints. Generalized linear model (GLM) was compared to quantile and ordinary least squares (OLS) regression to evaluate the association between ADI and ED LOS. Receipt of computed tomography or magnetic resonance imaging was the primary exposure. Emergency department LOS was the primary outcome.
Results |
Of the 33,685 ED visits analyzed, 17% involved ADI. The median LOS for patients without ADI was 138 minutes compared to 252 minutes for those who received ADI. Overall, GLM offered the most unbiased estimates, although it provided similar adjusted point estimates to OLS for the marginal change in LOS associated with ADI. The effect of imaging differed by LOS quantile, especially for patients with abdominal pain, fever, and back symptoms.
Conclusions |
Generalized linear model offered an improved modeling approach compared to OLS and quantile regression. Consideration of such techniques may facilitate a more complete view of the effect of ADI on ED LOS.
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| ☆ | Support and disclosures: This work was supported by the Robert Wood Johnson Foundation Clinical Scholars program and the US Department of Veterans Affairs (Dr Kanzaria), by grant 5 K12 HL109005 from the NHLBI (Dr Probst), and by grant KL2 RR024130 from the NIH/NCRR/OD UCSF-CTSI and the Robert Wood Johnson Physician Faculty Scholars Program (Dr Hsia). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of any of the funding agencies. There are no other conflicts of interest. |
| ☆☆ | Meeting: This work was presented at the Society for Academic Emergency Medicine meeting in Dallas, TX, May 13-17, 2014. |
Vol 32 - N° 10
P. 1253-1258 - octobre 2014 Retour au numéro
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