Cargando…

Appropriate use of medical imaging in two Spanish public hospitals: a cross-sectional analysis

OBJECTIVES: To determine the appropriateness of medical imaging examinations involving radiation and to estimate the effective radiation dose and costs associated. DESIGN: Cross-sectional retrospective study. SETTING: Two Spanish public tertiary hospitals. PARTICIPANTS: 2022 medical imaging tests we...

Descripción completa

Detalles Bibliográficos
Autores principales: Vilar-Palop, Jorge, Hernandez-Aguado, Ildefonso, Pastor-Valero, María, Vilar, José, González-Alvarez, Isabel, Lumbreras, Blanca
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5857681/
https://www.ncbi.nlm.nih.gov/pubmed/29549204
http://dx.doi.org/10.1136/bmjopen-2017-019535
_version_ 1783307513651789824
author Vilar-Palop, Jorge
Hernandez-Aguado, Ildefonso
Pastor-Valero, María
Vilar, José
González-Alvarez, Isabel
Lumbreras, Blanca
author_facet Vilar-Palop, Jorge
Hernandez-Aguado, Ildefonso
Pastor-Valero, María
Vilar, José
González-Alvarez, Isabel
Lumbreras, Blanca
author_sort Vilar-Palop, Jorge
collection PubMed
description OBJECTIVES: To determine the appropriateness of medical imaging examinations involving radiation and to estimate the effective radiation dose and costs associated. DESIGN: Cross-sectional retrospective study. SETTING: Two Spanish public tertiary hospitals. PARTICIPANTS: 2022 medical imaging tests were extracted from the radiology information system in February and March of 2014. MRI and ultrasound examinations were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES: Five outcomes were set independently by at least two researchers according to four guidelines: (1) appropriate; (2) inappropriate; (3) inappropriate due to repetition, if the timing to carry out next diagnostic tests was incorrect according to guidelines; (4) not adequately justified, if the referral form did not include enough clinical information to allow us to understand the patient’s clinical condition; and (5) not included in the guidelines, if the referral could not be matched to a clinical scenario described in the guidelines. We estimated the prevalence of the five categories according to relevant clinical and sociodemographic variables and the effective radiation dose and costs for each category. RESULTS: Approximately half of the imaging tests were deemed as appropriate (967, 47.8%) while one-third (634, 31.4%) were considered inappropriate. 19.6% of the effective dose and 25.2% of the cost were associated with inappropriate tests. Women were less likely than men to have an imaging test classified as appropriate (adjusted OR 0.70,95% CI 0.57 to 0.86). Imaging tests requested by general practitioners were less likely to be considered appropriate than those requested by central services (adjusted OR 0.60, 95% CI 0.38 to 0.93). Mammography and CT were more likely to be appropriate than conventional X-rays. CONCLUSION: There was a significant frequency of inappropriateness, which resulted in a high percentage of associated effective radiation dose. Percentage of inappropriateness depends on sociodemographic and clinical characteristics such as sex, age, referral physician and medical imaging test.
format Online
Article
Text
id pubmed-5857681
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-58576812018-03-20 Appropriate use of medical imaging in two Spanish public hospitals: a cross-sectional analysis Vilar-Palop, Jorge Hernandez-Aguado, Ildefonso Pastor-Valero, María Vilar, José González-Alvarez, Isabel Lumbreras, Blanca BMJ Open Radiology and Imaging OBJECTIVES: To determine the appropriateness of medical imaging examinations involving radiation and to estimate the effective radiation dose and costs associated. DESIGN: Cross-sectional retrospective study. SETTING: Two Spanish public tertiary hospitals. PARTICIPANTS: 2022 medical imaging tests were extracted from the radiology information system in February and March of 2014. MRI and ultrasound examinations were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES: Five outcomes were set independently by at least two researchers according to four guidelines: (1) appropriate; (2) inappropriate; (3) inappropriate due to repetition, if the timing to carry out next diagnostic tests was incorrect according to guidelines; (4) not adequately justified, if the referral form did not include enough clinical information to allow us to understand the patient’s clinical condition; and (5) not included in the guidelines, if the referral could not be matched to a clinical scenario described in the guidelines. We estimated the prevalence of the five categories according to relevant clinical and sociodemographic variables and the effective radiation dose and costs for each category. RESULTS: Approximately half of the imaging tests were deemed as appropriate (967, 47.8%) while one-third (634, 31.4%) were considered inappropriate. 19.6% of the effective dose and 25.2% of the cost were associated with inappropriate tests. Women were less likely than men to have an imaging test classified as appropriate (adjusted OR 0.70,95% CI 0.57 to 0.86). Imaging tests requested by general practitioners were less likely to be considered appropriate than those requested by central services (adjusted OR 0.60, 95% CI 0.38 to 0.93). Mammography and CT were more likely to be appropriate than conventional X-rays. CONCLUSION: There was a significant frequency of inappropriateness, which resulted in a high percentage of associated effective radiation dose. Percentage of inappropriateness depends on sociodemographic and clinical characteristics such as sex, age, referral physician and medical imaging test. BMJ Publishing Group 2018-03-16 /pmc/articles/PMC5857681/ /pubmed/29549204 http://dx.doi.org/10.1136/bmjopen-2017-019535 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Radiology and Imaging
Vilar-Palop, Jorge
Hernandez-Aguado, Ildefonso
Pastor-Valero, María
Vilar, José
González-Alvarez, Isabel
Lumbreras, Blanca
Appropriate use of medical imaging in two Spanish public hospitals: a cross-sectional analysis
title Appropriate use of medical imaging in two Spanish public hospitals: a cross-sectional analysis
title_full Appropriate use of medical imaging in two Spanish public hospitals: a cross-sectional analysis
title_fullStr Appropriate use of medical imaging in two Spanish public hospitals: a cross-sectional analysis
title_full_unstemmed Appropriate use of medical imaging in two Spanish public hospitals: a cross-sectional analysis
title_short Appropriate use of medical imaging in two Spanish public hospitals: a cross-sectional analysis
title_sort appropriate use of medical imaging in two spanish public hospitals: a cross-sectional analysis
topic Radiology and Imaging
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5857681/
https://www.ncbi.nlm.nih.gov/pubmed/29549204
http://dx.doi.org/10.1136/bmjopen-2017-019535
work_keys_str_mv AT vilarpalopjorge appropriateuseofmedicalimagingintwospanishpublichospitalsacrosssectionalanalysis
AT hernandezaguadoildefonso appropriateuseofmedicalimagingintwospanishpublichospitalsacrosssectionalanalysis
AT pastorvaleromaria appropriateuseofmedicalimagingintwospanishpublichospitalsacrosssectionalanalysis
AT vilarjose appropriateuseofmedicalimagingintwospanishpublichospitalsacrosssectionalanalysis
AT gonzalezalvarezisabel appropriateuseofmedicalimagingintwospanishpublichospitalsacrosssectionalanalysis
AT lumbrerasblanca appropriateuseofmedicalimagingintwospanishpublichospitalsacrosssectionalanalysis