Trend and Factors Associated with Repeat Computed Tomography Examinations in Tertiary Hospitals: Linked Health Administrative Data in Western Australia

IntroductionComputed tomography (CT) has become an essential part of clinical practice. However, repeat CT scans has raised a concern about unnecessary exposure to ionising radiation and waste of health care resource. While substantial effort is underway to reduce inappropriate use of diagnostic imaging tests including CT, little evidence of any change in repeat CT use and its associated factors. Objectives and ApproachThis study aimed to measure trend in repeat CT use and identify factors associated with repeat CT use in tertiary hospitals in Western Australia (WA). This study used WA linked administrative records from hospital morbidity, emergency department presentations, and picture archiving and communication system datasets to capture all tertiary hospitalisations and number of CT use during the admission from 2003 to 2015. Multivariate logistic regression was used to examine trend and determine characteristics associated with repeat CT, for admissions with and without major surgery during hospitalisation. ResultsAmong 303,439 admissions with CT scan 11.9% had repeat CT scan in the same anatomic areas. While the probability of repeat CT among admission with surgery remained unchanged over the study period, its counterpart significantly reduced about 4% per year. Regardless of surgical status, repeat CT scanning was significantly lower among females, Indigenous and older age groups but higher among people living in rural and remote areas. We found that admissions for circulatory conditions, injuries, cancer or multimorbidity had significantly higher probability of having repeat CT. Conclusion / ImplicationsThis study indicates that clinical factors such as cancer, injury and multimorbidity are factors contributing to repeat CT. A reduction of repeat CT over the study period among admissions without surgical procedure suggests a potential reduction of unnecessary CT scan, although further study is needed to fully capture whether this is an actual change in practice.

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Factors driving CT utilisation in tertiary hospitals: a decomposition analysis using linked administrative data in Western Australia

BMJ Open ◽

10.1136/bmjopen-2021-052954 ◽

2021 ◽

Vol 11 (11) ◽

pp. e052954

Author(s):

Ninh Thi Ha ◽

Susannah Maxwell ◽

Max K Bulsara ◽

Jenny Doust ◽

Donald Mcrobbie ◽

...

Keyword(s):

Ct Scan ◽

Western Australia ◽

Hospital Admissions ◽

Decomposition Analysis ◽

Ct Scanning ◽

Patient Characteristics ◽

High Risk Population ◽

Clinical Practices ◽

Relative Probability ◽

Tertiary Hospitals

ObjectivesWhile CT scanning plays a significant role in healthcare, its increasing use has raised concerns about inappropriate use. This study investigated factors driving the changing use of CT among people admitted to tertiary hospitals in Western Australia (WA).Design and settingA repeated cross-sectional study of CT use in WA in 2003–2005 and 2013–2015 using linked administrative heath data at the individual patient level.ParticipantsA total of 2 375 787 tertiary hospital admissions of people aged 18 years or older.Main outcome measureRate of CT scanning per 1000 hospital admissions.MethodsA multivariable decomposition model was used to quantify the contribution of changes in patient characteristics and changes in the probability of having a CT over the study period.ResultsThe rate of CT scanning increased by 112 CT scans per 1000 admissions over the study period. Changes in the distribution of the observed patient characteristics were accounted for 62.7% of the growth in CT use. However, among unplanned admissions, changes in the distribution of patient characteristics only explained 17% of the growth in CT use, the remainder being explained by changes in the probability of having a CT scan. While the relative probability of having a CT scan generally increased over time across most observed characteristics, it reduced in young adults (−2.8%), people living in the rural/remote areas (−0.8%) and people transferred from secondary hospitals (−0.8%).ConclusionsOur study highlights potential improvements in practice towards reducing medical radiation exposure in certain high risk population. Since changes in the relative probability of having a CT scan (representing changes in scope) rather than changes in the distribution of the patient characteristics (representing changes in need) explained a major proportion of the growth in CT use, this warrants more in-depth investigations in clinical practices to better inform health policies promoting appropriate use of diagnostic imaging tests.

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The Frequency of and Indications for General Anaesthesia in Children in Western Australia 2002–2003

Anaesthesia and Intensive Care ◽

10.1177/0310057x0503300512 ◽

2005 ◽

Vol 33 (5) ◽

pp. 623-628 ◽

Cited By ~ 5

Author(s):

C. Sims ◽

B. Stanley ◽

E. Milne

Keyword(s):

Western Australia ◽

Health Department ◽

Bimodal Distribution ◽

Common Category ◽

Morbidity Data ◽

Tertiary Hospitals ◽

Hospital Morbidity ◽

One Year ◽

Retrospective Database ◽

Nose And Throat

We conducted a retrospective database search of the Hospital Morbidity Data System at the Health Department of Western Australia to determine the number of anaesthetics given to children aged 16 years or less in Western Australia over a twelve-month period. Information was also collected to assess the types of surgery for which anaesthesia was being provided, and the categories of hospital in which children were being anaesthetized. We found that 28,522 anaesthetics were given to 24,981 children, and 2,462 (9.9%) children had more than one anaesthetic. Five and a half percent of the children in Western Australia had an anaesthetic during the twelve months studied. The most common types of surgery were ear nose and throat (28% of anaesthetics), general (21%), dental/oral procedures (17%) and orthopaedic (15%). There was a bimodal distribution in the incidence of anaesthesia versus age, with peaks at 4 years and at 16 years. The most common category of hospital that children were anaesthetized in was private metropolitan (40%) followed by tertiary (38%), rural (14%) and public metropolitan (8%). One thousand, seven hundred and seven children aged less than one year were given an anaesthetic. These anaesthetics were most frequently given to children in tertiary hospitals (62%) followed by private metropolitan (30%), public metropolitan (6%) and rural hospitals (2%).

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Health care financing and public responses: use of private insurance in Western Australia during 1980–2001

Australian Health Review ◽

10.1071/ah060073 ◽

2006 ◽

Vol 30 (1) ◽

pp. 73 ◽

Cited By ~ 2

Author(s):

Rachael Moorin ◽

Kate J Brameld ◽

C D'Arcy J Holman

Keyword(s):

Policy Change ◽

Western Australia ◽

Private Insurance ◽

Health Care Financing ◽

Age Groups ◽

Policy Makers ◽

The Public ◽

Morbidity Data ◽

The Difference ◽

Hospital Morbidity

Objectives: The aim was to identify and explain trends and cut points in payment classification (privately insured or otherwise) for episodes of hospitalisation in Western Australia. Methods: Hospital morbidity data from 1980 to 2001 were used to produce trend lines of the proportion of hospital separations in each payment category in each year in age and clinical subgroups. Results: The most significant changes in payment classification over time were found in all groups between 1980 and 1984, corresponding to a period when free public hospital care in Australia was abolished (Sep 1981 to Feb 1984). The trend associated with this policy change rebounded significantly just before the introduction of Medicare in 1984. These observations were consistent over all age groups except in the oldest group (70+ years). This trend was more pronounced for the surgical subgroup compared with other broad clinical categories. More recently, a trend towards increasing public episodes was reversed from 2000 following introduction of incentives for private health cover and sanctions against deferred uptake in younger people. Conclusion: The public appeared to adopt a shortterm crisis reaction to major policy change but then reversed towards past patterns of behaviour. The implications for policy makers include the need to understand the underlying culture of the population; to realise that attitudes become fixed as people age; and to recognise the difference in the effectiveness of incentive- and deterrent-based policies.

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Requesting physicians’ knowledge of X-radiation exposure from computed tomography scan examinations: A case study of two Nigerian tertiary hospitals

Calabar Journal of Health Sciences ◽

10.25259/cjhs_9_2019 ◽

2020 ◽

Vol 3 ◽

pp. 36-39

Author(s):

Samson O. Paulinus ◽

Benjamin E. Udoh ◽

Bassey E. Archibong ◽

Akpama E. Egong ◽

Akwa E. Erim ◽

...

Keyword(s):

Computed Tomography ◽

Ionizing Radiation ◽

Ct Scan ◽

Radiation Exposure ◽

Work Experience ◽

Radiation Risk ◽

Radiological Protection ◽

X Ray ◽

Tertiary Hospitals ◽

Medical Exposure

Objective: Physicians who often request for computed tomography (CT) scan examinations are expected to have sound knowledge of radiation exposure (risks) to patients in line with the basic radiation protection principles according to the International Commission on Radiological Protection (ICRP), the Protection of Persons Undergoing Medical Exposure or Treatment (POPUMET), and the Ionizing Radiation (Medical Exposure) Regulations (IR(ME)R). The aim is to assess the level of requesting physicians’ knowledge of ionizing radiation from CT scan examinations in two Nigerian tertiary hospitals. Materials and Methods: An 18-item-based questionnaire was distributed to 141 practicing medical doctors, excluding radiologists with work experience from 0 to >16 years in two major teaching hospitals in Nigeria with a return rate of 69%, using a voluntary sampling technique. Results: The results showed that 25% of the respondents identified CT thorax, abdomen, and pelvis examination as having the highest radiation risk, while 22% said that it was a conventional chest X-ray. Furthermore, 14% concluded that CT head had the highest risk while 9% gave their answer to be conventional abdominal X-ray. In addition, 17% inferred that magnetic resonance imaging had the highest radiation risk while 11% had no idea. Furthermore, 25.5% of the respondents have had training on ionizing radiation from CT scan examinations while 74.5% had no training. Majority (90%) of the respondents were not aware of the ICRP guidelines for requesting investigations with very little (<3%) or no knowledge (0%) on the POPUMET and the IR(ME)R respectively. Conclusion: There is low level of knowledge of ionizing radiation from CT scan examinations among requesting physicians in the study locations.

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Reference values and factors associated with hand grip strength among older adults living in southeastern Poland

Scientific Reports ◽

10.1038/s41598-021-89408-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Agnieszka Wiśniowska-Szurlej ◽

Agnieszka Ćwirlej-Sozańska ◽

Justyna Kilian ◽

Natalia Wołoszyn ◽

Bernard Sozański ◽

...

Keyword(s):

Older Adults ◽

Older People ◽

Reference Values ◽

Handgrip Strength ◽

Age Groups ◽

Cross Sectional Study ◽

Normative Values ◽

Dominant Hand ◽

Cross Sectional ◽

Factors Associated

AbstractHandgrip strength (HGS) is used as a biomarker for the state of health of older people, but the number of research publications containing the normative values of HGS in older adult populations is limited. The aim of the study was to define reference values and factors associated with HGS in older adults living in southeastern Poland. A cross-sectional study including 405 participants aged 65 and older was conducted. Handgrip strength for the dominant hand was assessed by the average of three trials using a JAMAR dynamometer. The sample was categorized into the following age groups: 65–69 years, 70–74 years, 75–79 years, 80–84 years, 85 and over. The average HGS was 19.98 kg (16.91 kg for women and 26.19 kg for men). There was a decrease in handgrip strength across the age range in both sexes. The average handgrip strength of the older people was 17.97 kg (14.47 kg for women and 25.66 kg for men) for those aged 80–85 and 16.68 kg (13.51 kg for women and 21.77 kg for men) in the group over 85 years old. In both sexes, marital status was an independent factor associated with reduced handgrip strength. In conclusion, this study described, for the first time, handgrip strength values for the southeastern Polish population aged ≥ 65 years according to age and gender.

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Age differences in mortality in patients undergoing surgery for infective endocarditis

European Heart Journal ◽

10.1093/ehjci/ehaa946.2021 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

L Ostergaard ◽

M.H Smerup ◽

K Iversen ◽

A.D Jensen ◽

A Dahl ◽

...

Keyword(s):

Infective Endocarditis ◽

Aortic Valve ◽

Hospital Mortality ◽

Hazard Analysis ◽

Age Groups ◽

Prosthetic Heart Valve ◽

Valve Surgery ◽

Aortic Valve Surgery ◽

Factors Associated ◽

Increased Risk

Abstract Background Infective endocarditis (IE) is associated with high mortality. Surgery may improve survival, but the intercept between benefit and harm is hard to balance and may be closely related to age. Purpose To examine the in-hospital and 90-day mortality in patients undergoing surgery for IE and to identify differences between age groups and type of valvular intervention. Methods By crosslinking nationwide Danish registries we identified patients with first-time IE undergoing surgical treatment in the period from 2000 to 2017. The study population was grouped in patients <60 years, 60–75 years, and ≥75 years of age. High-risk subgroups by age and surgical valve intervention (mitral vs aortic vs mitral+aortic) during IE admission were examined. Kaplan Meier estimates was used to identify 90-day mortality by age groups and multivariable adjusted Cox proportional hazard analysis was used to examine factors associated with 90-day mortality. Results We included 1,767 patients with IE undergoing surgery, 735 patients <60 years (24.1% female), 766 patients 60–75 years (25.8% female), and 266 patients >75 years (36.1% female). The proportion of patients with IE undergoing surgery was 35.3%, 26.9%, and 9.1% for patients <60 years, 60–75 years, and >75 years, respectively. For patients with IE undergoing surgery, the in-hospital mortality was 6.4%, 13.6%, and 20.3% for patients <60 years, 60–75 years, and ≥75 years of age, respectively and mortality at 90 days were 7.5%, 13.9%, and 22.3%, respectively. Factors associated with an increased risk 90-day mortality were: mitral valve surgery and a combination of mitral and aortic valve surgery as compared with isolated aortic valve surgery, patients 60–75 years and >75 years as compared with patients aged <60 years, prosthetic heart valve prior to IE admission, and diabetes, Figure. Patients >75 years undergoing a combination of mitral and aortic valve surgery had an in-hospital mortality of 36.3%. Conclusion In patients undergoing surgery for IE, a stepwise increase in 90-day mortality was seen for age groups, highest among patients >75 years with a 90-day mortality of more than 20%. Patients undergoing mitral and combined mitral and aortic valve surgery as compared to isolated aortic valve surgery were associated with a higher mortality. These findings may be of importance for the management strategy of patients with IE. Mortality risk Funding Acknowledgement Type of funding source: None

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Image Registration of 18F-FDG PET/CT Using the MotionFree Algorithm and CT Protocols through Phantom Study and Clinical Evaluation

Healthcare ◽

10.3390/healthcare9060669 ◽

2021 ◽

Vol 9 (6) ◽

pp. 669

Author(s):

Deok-Hwan Kim ◽

Eun-Hye Yoo ◽

Ui-Seong Hong ◽

Jun-Hyeok Kim ◽

Young-Heon Ko ◽

...

Keyword(s):

Ct Scan ◽

Ct Scanning ◽

Motion Artifacts ◽

Scanning Time ◽

Pet Ct ◽

Static Images ◽

Type C ◽

Natural Breathing ◽

Fdg Pet Ct ◽

Patient Studies

We evaluated the benefits of the MotionFree algorithm through phantom and patient studies. The various sizes of phantom and vacuum vials were linked to RPM moving with or without MotionFree application. A total of 600 patients were divided into six groups by breathing protocols and CT scanning time. Breathing protocols were applied as follows: (a) patients who underwent scanning without any breathing instructions; (b) patients who were instructed to hold their breath after expiration during CT scan; and (c) patients who were instructed to breathe naturally. The length of PET/CT misregistration was measured and we defined the misregistration when it exceeded 10 mm. In the phantom tests, the images produced by the MotionFree algorithm were observed to have excellent agreement with static images. There were significant differences in PET/CT misregistration according to CT scanning time and each breathing protocol. When applying the type (c) protocol, decreasing the CT scanning time significantly reduced the frequency and length of misregistrations (p < 0.05). The MotionFree application is able to correct respiratory motion artifacts and to accurately quantify lesions. The shorter time of CT scan can reduce the frequency, and the natural breathing protocol also decreases the lengths of misregistrations.

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Radiation dosimetry assessment of routine CT scanning protocols used in Western Australia

Journal of Radiological Protection ◽

10.1088/0952-4746/33/2/295 ◽

2013 ◽

Vol 33 (2) ◽

pp. 295-312 ◽

Cited By ~ 10

Author(s):

Rachael E Moorin ◽

Rene Forsyth ◽

David J Gibson ◽

Richard Fox

Keyword(s):

Western Australia ◽

Radiation Dosimetry ◽

Ct Scanning

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Selective non-operative management of anterior abdominal stab wounds with emphasis on the value of follow-up abdominal CT scanning

Trauma ◽

10.1177/1460408617706389 ◽

2017 ◽

Vol 20 (3) ◽

pp. 194-202

Author(s):

El Yamani Fouda ◽

Alaa Magdy ◽

Sameh Hany Emile

Keyword(s):

Ct Scan ◽

Ct Scanning ◽

Operative Management ◽

Abdominal Ct ◽

Management Group ◽

Abdominal Ct Scan ◽

Laparotomy Group ◽

Abdominal Stab Wounds ◽

Non Operative Management

Background and aim Selective non-operative management of patients with penetrating abdominal stabs is the preferred treatment strategy. The present study aimed to assess the efficacy and safety of non-operative management with emphasis on the value of follow-up abdominal CT scanning in management of patients with penetrating anterior abdominal stab. Patients and methods This is a retrospective chart review of stable patients with anterior abdominal stab wounds. Patients were divided in terms of initial decisions into two groups: laparotomy group and non-operative management group. Abdominal CT scan was performed for patients in the non-operative management group on admission and follow-up CT scanning was performed in cases of clinical and/or biochemical deterioration. Results The laparotomy group included 82 patients and 68.2% of them had unnecessary laparotomies. The non-operative management group comprised 97 patients and 90.7% of them did not require subsequent laparotomy. Abdominal CT scan had a sensitivity of 88.9% and specificity of 100% in detection of intra-abdominal injuries. Follow-up CT scanning detected bowel injuries missed by initial CT scan in three patients. The non-operative management group had significantly lower post-operative complication rate than the laparotomy group (4.1% vs. 18.3%), with a significantly shorter length of stay. Conclusions Non-operative management is the optimal management strategy for stable patients with penetrating anterior abdominal stab to decrease unnecessary laparotomy rates, hospital stay and costs. Follow-up abdominal CT scanning facilitated the decision making for patients selected for non-operative management and is highly sensitive in the diagnosis of patients who require subsequent exploration.

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