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Radiologists predict differential resource utilization but not clinical outcome in emergency department patients imaged with ultrasound for right upper quadrant pain

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Abstract

Purpose

Radiologists with diverse training, specialization, and habits interpret imaging in the Emergency Department. It is necessary to understand if their variation predicts differential value. The purpose of this study was to determine whether attending radiologist variation predicts major clinical outcomes in adult Emergency Department patients imaged with ultrasound for right upper quadrant pain.

Methods

Consecutive ED patients imaged with ultrasound for RUQ pain from 10/8/2016 to 8/10/2022 were included (N = 7097). The primary outcome was prediction of hospital admission by signing attending radiologist. Secondary outcomes included: ED and hospital length of stay (LOS), 30-day mortality, 30-day re-presentation rate, subspecialty consultation, advanced imaging follow up (HIDA, MRI, CT), and intervention (ERCP, drainage or surgery). Sample size was determined a priori (detectable effect size: w = 0.06). Data were adjusted for demographic data, Elixhauser comorbidities, number of ED visits in prior year, clinical data, and system factors (38 covariates). P-values were corrected for multiple comparisons (false discovery rate-adjusted p-values).

Results

The included ultrasounds were read by 35 radiologists (median exams/radiologist: 145 [74.5-241.5]). Signing radiologist did not predict hospitalization (p = 0.85), abdominopelvic surgery or intervention within 30 days, re-presentation to the Emergency Department within 30 days, or subspecialty consultation. Radiologist did predict difference in Emergency Department length of stay (p < 0.001) although this difference was small and imprecise. HIDA was mentioned variably by radiologists (range 0–19%, p < 0.001), and mention of HIDA in the ultrasound report increased 10-fold the odds of HIDA being performed in the next 72 h (odds ratio 10.4 [8.0-13.4], p < 0.001).

Conclusion

Radiologist variability did not predict meaningful outcome differences for patients with right upper quadrant pain undergoing ultrasound in the Emergency Department, but when radiologists mention HIDA in their reports, it predicts a 10-fold increase in the odds a HIDA is performed. Radiologists are relied on for interpretation that shapes subsequent patient care, and it is important to consider how radiologist variability can influence both outcome and resource utilization.

Highlights

Key finding: In 7,097 patients who underwent RUQ ultrasound in the Emergency Department (ED), radiologist variation did not predict major clinical outcomes including hospitalization (p = 0.85), 30-day abdominopelvic surgery or intervention, 30-day re-presentation to the ED, or subspecialty consultation. Radiologists mentioned HIDA variably (0—19%, p < 0.001), and inclusion of HIDA in ultrasound reports predicted a 10-fold increase in the odds of HIDA being performed in the next 72 h (p < 0.001).

Importance: Mention of HIDA in ED right upper quadrant ultrasound reports predicts a 10-fold increase in HIDA utilization, but radiologist variation does not predict differences in major clinical outcomes.

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Abbreviations

ED:

Emergency department

RUQ:

Right upper quadrant

CPT:

Current Procedural Terminology

HIDA:

Hepatobiliary iminodiacetic acid

ERCP:

Endoscopic retrograde cholangiopancreatography

ICC:

Intra-cluster correlation

RR:

Relative risk

OR:

Odds ratio

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Funding

This work was supported in part by the National Center for Advancing Translational Sciences for the Michigan Institute for Clinical and Health Research (UL1TR002240).

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Authors and Affiliations

  1. Department of Radiology, University of Michigan, Ann Arbor, MI, USA

    Sonia Gaur, Joshua Breeden, Daniel Barkmeier, Prasad R. Shankar & Matthew S. Davenport

  2. Department of Radiology, Massachusetts General Hospital, Boston, MA, USA

    Sonia Gaur

  3. Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA

    Jonathan P. Troost & Shokoufeh Khalatbari

  4. Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, USA

    Christopher M. Fung

  5. Imaging Institute, Cleveland Clinic, Cleveland, OH, USA

    Prasad R. Shankar

  6. Department of Urology, University of Michigan, Ann Arbor, MI, USA

    Matthew S. Davenport

Authors
  1. Sonia Gaur
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  2. Jonathan P. Troost
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  3. Christopher M. Fung
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  4. Joshua Breeden
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  7. Shokoufeh Khalatbari
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  8. Matthew S. Davenport
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Corresponding author

Correspondence to Sonia Gaur.

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Disclosures

1. Gaur: Royalties from the National Institutes of Health for licensed intellectual property.

2. Davenport: Unrelated royalties from Wolters-Kluwers and uptodate.com, Treasurer and Board of Directors for the Society of Advanced Body Imaging, Associate Editor of RADIOLOGY.

3. Troost: Grants from the National Center for Advancing Translational Sciences/National Institutes of Health (UL1TR002240 and UM1TR004404) outside the submitted work.

4. Khalatbari: Grants from the National Center for Advancing Translational Sciences/National Institutes of Health (UL1TR002240) outside the submitted work.

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Gaur, S., Troost, J.P., Fung, C. et al. Radiologists predict differential resource utilization but not clinical outcome in emergency department patients imaged with ultrasound for right upper quadrant pain. Abdom Radiol (2024). https://doi.org/10.1007/s00261-024-04244-5

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  • DOI: https://doi.org/10.1007/s00261-024-04244-5

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