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Use of diagnostic imaging in the emergency department for cervical spine injuries in Kingston, Ontario

Published online by Cambridge University Press:  04 March 2015

William Pickett ,
Atif Kukaswadia ,
Wendy Thompson ,
Mylene Frechette ,
Steven McFaull ,
Hilary Dowdall  and
Robert J. Brison
William Pickett*
Affiliation:
Department of Emergency Medicine, Queen’s University, Kingston, ON Department of Public Health Sciences, Queen’s University, Kingston, ON
Atif Kukaswadia
Affiliation:
Department of Public Health Sciences, Queen’s University, Kingston, ON
Wendy Thompson
Affiliation:
Department of Injury Section, Health Surveillance and Epidemiology Division, Public Health Agency of Canada, Ottawa, ON
Mylene Frechette
Affiliation:
Department of Injury Section, Health Surveillance and Epidemiology Division, Public Health Agency of Canada, Ottawa, ON
Steven McFaull
Affiliation:
Department of Injury Section, Health Surveillance and Epidemiology Division, Public Health Agency of Canada, Ottawa, ON
Hilary Dowdall
Affiliation:
Department of Public Health Sciences, Queen’s University, Kingston, ON
Robert J. Brison
Affiliation:
Department of Emergency Medicine, Queen’s University, Kingston, ON Department of Public Health Sciences, Queen’s University, Kingston, ON
*
Emergency Medicine Research, Queen’s University, Angada 3, Kingston General Hospital, 76 Stuart Street, Kingston, ON K7L 2V7; will.pickett@queensu.ca

Abstract

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Objectives:

This study assessed the use and clinical yield of diagnostic imaging (radiography, computed tomography, and medical resonance imaging) ordered to assist in the diagnosis of acute neck injuries presenting to emergency departments (EDs) in Kingston, Ontario, from 2002–2003 to 2009–2010.

Methods:

Acute neck injury cases were identified using records from the Kingston sites of the Canadian National Ambulatory Care Reporting System. Use of radiography was analyzed over time and related to proportions of cases diagnosed with clinically significant cervical spine injuries.

Results:

A total of 4,712 neck injury cases were identified. Proportions of cases referred for diagnostic imaging to the neck varied significantly over time, from 30.4% in 2002–2003 to 37.6% in 2009–2010 (ptrend = 0.02). The percentage of total cases that were positive for clinically significant cervical spine injury (“clinical yield”) also varied from a low of 5.8% in 2005–2006 to 9.2% in 2008–2009 (ptrend = 0.04), although the clinical yield of neck-imaged cases did not increase across the study years (ptrend = 0.23). Increased clinical yield was not observed in association with higher neck imaging rates whether that yield was expressed as a percentage of total cases positive for clinically significant injury (p = 0.29) or as a percentage of neck-imaged cases that were positive (p = 0.77).

Conclusions:

We observed increases in the use of diagnostic images over time, reflecting a need to reinforce an existing clinical decision rule for cervical spine radiography. Temporal increases in the clinical yield for total cases may suggest a changing case mix or more judicious use of advanced types of diagnostic imaging.

Keywords

emergency medicineepidemiologyinjurymedical record linkagephysician’s practice patternsradiography
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 16 , Issue 1 , January 2014 , pp. 25 - 33
Copyright
Copyright © Canadian Association of Emergency Physicians 2014

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