| Summary: | 碩士 === 高雄醫學大學 === 醫學影像暨放射科學系碩士班 === 104 === Purpose
The role of computed tomography (CT) in Traumatic Brain Injury (TBI) has increased substantially in recent years and we conduct a nationwide population study to evaluate the temporal trends in Taiwan.
Materials and Methods
This retrospective nationwide study analyzed administrative claims data obtained from the Taiwan Bureau of National Health Insurance (BNHI) from 2006 to 2011. We assessed changes during this period in CT use of ED TBI patients. Main outcomes were presented as adjusted risk ratios (RRs).
Results
Data from 41816 TBI visits during the 6-year period yielded the rate of CT use increased 41.71% without increased TBI patients (Fig1). After multivariable adjustment, the overall likelihood of CT use over time was 1.60-fold (adjusted RR 1.60; 95% CI 1.49% to 1.72%) (Table 1). Rate of growth were highest in more than 79 year-old group (adjusted RR 6.79; 95% CI 6.09% to 7.58%),the next two group were 65-79 year-old (adjusted RR 4.83; 95% CI 4.44% to 5.25%) and 50-64 year-old (adjusted RR 3.18; 95% CI 2.96% to 3.41%) . No significant influence was found in gender, comorbidity, hospital level and ED physician seniority (Table 2). From 2006 to 2007 and 2010 to 2011, there were decrease rate in less than 18 year-old group (Figure 2). The cost of admitted TBI via ED had no significant change during the six years, neither in the different age groups. Cost increased in the more severe cormobidity; it decreased in female, lower hospital level and senior ED physician (Table 3).
Discussion
Despite long-standing awareness about the harm of ionization radiation and prediction rules designed to minimize neuroimaging in minor head injury, head CT use for traumatic brain injury patients still increased(1). Emergency physicians should continue to apply evidence-based guidelines for neuroimaging, and should consider strategies to maximize use of validated prediction rules to minimize unnecessary radiation and cost associated with head CT use (2).
Conclusion
CT utilization increased over time in the ED TBI patients and elderly accounts for the main cause of increasing use. The seniority of emergency physicians can decrease TBI hospitalization cost.
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