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Chief complaints and computed tomography results in the emergency department: a three-year retrospective cohort study
Cheng-Yi Fan1, Chi-Hsin Chen1, Jiun-Wei Chen1
1Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, 300, Taiwan.
Insights
Patient chief complaints significantly influence computed tomography (CT) scan results in emergency department (ED) revisits. Abdominal pain strongly predicts positive abdominopelvic CT findings, guiding effective diagnostic imaging.
Area of Science:
- Emergency Medicine
- Radiology
- Clinical Decision Making
Background:
- Computed tomography (CT) is common in emergency department (ED) patients who return within 72 hours.
- The utility of chief complaints in guiding CT use for these patients is unclear.
Purpose of the Study:
- To investigate the association between patient chief complaints and computed tomography (CT) findings in emergency department (ED) revisits.
- To determine if chief complaints effectively predict positive CT results.
Main Methods:
- Retrospective cohort study of adult patients returning to the ED (2019-2021).
- Data collected included demographics, pre-existing conditions, chief complaints, and CT region.
- Logistic regression analysis was used to assess the relationship between chief complaints and positive CT results.
Main Results:
- Of 7,699 revisits, 1,202 (15.6%) had CT scans.
- Abdominal pain and gastrointestinal symptoms were linked to higher positive abdominopelvic CT rates (OR 2.83).
- Central nervous system and cardiopulmonary complaints showed no association or a negative association with new positive CT findings.
Conclusions:
- Patient chief complaints correlate with the diagnostic yield of CT scans in the emergency department (ED) on patient revisits.
- Physicians should leverage chief complaint data to optimize the use of CT imaging for returning ED patients.
Background:
Computed tomography (CT) is frequently performed in the patients who admitted to the emergency department (ED), discharged but returned to ED within 72 h. It is unknown whether the main complaints of patients assist physicians to use CT effectively. This study aimed to find the association between chief complaints and the CT results.
Methods:
This three-year retrospective cohort study was conducted in the ED of a tertiary medical center. Adult patients who returned to the ED after the index visit were included from 2019 to 2021. Demographics, pre-existing diseases, chief complaints, and CT region were recorded by independent ED physicians. A logistic regression model with an odds ratio (OR) and 95% confidence interval (CI) was used to determine the relationship between chief complaints and positive CT results.
Results:
In total, 7,699 patients revisited ED after the index visit; 1,202 (15.6%) received CT. The top chief complaints in patients who received CT were abdominal pain, dizziness, and muscle weakness. Patients with abdominal pain or gastrointestinal symptoms had a significantly higher rate of positive abdominopelvic CT than those without it (OR 2.83, 95% CI 1.98-4.05, p < 0.001), while the central nervous system and cardiopulmonary chief complaints were not associated (or negatively associated) with new positive CT findings.
Conclusion:
Chief complaints of patients on revisit to the ED are associated with different yields of new findings when CT scans of the chest, abdomen and head are performed. Physicians should consider these differential likelihoods of new positive findings based on these data.
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