Trend in CT utilisation and its impact on length of stay, readmission and hospital mortality in Western Australia tertiary hospitals: an analysis of linked administrative data 2003–2015
Objective High use of CT scanning has raised concern due to the potential ionising radiation exposure. This study examined trends of CT during admission to tertiary hospitals and its associations with length of stay (LOS), readmission and mortality.Design Retrospective observational study from 2003...
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BMJ Publishing Group
2022-06-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/6/e059242.full |
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| author | Rachael Moorin Max K Bulsara Jenny Doust David Youens Donald Mcrobbie John Slavotinek Thi Ninh Ha Cameron Wright Sviatlana Kamarova |
| author_facet | Rachael Moorin Max K Bulsara Jenny Doust David Youens Donald Mcrobbie John Slavotinek Thi Ninh Ha Cameron Wright Sviatlana Kamarova |
| author_sort | Rachael Moorin |
| collection | DOAJ |
| description | Objective High use of CT scanning has raised concern due to the potential ionising radiation exposure. This study examined trends of CT during admission to tertiary hospitals and its associations with length of stay (LOS), readmission and mortality.Design Retrospective observational study from 2003 to 2015.Setting West Australian linked administrative records at individual level.Participants 2 375 787 episodes of tertiary hospital admission in adults aged 18+ years.Main outcome measures LOS, 30-day readmissions and mortality stratified by CT use status (any, multiple (CTs to multiple areas during episode), and repeat (repeated CT to the same area)).Methods Multivariable regression models were used to calculate adjusted rate of CT use status. The significance of changes since 2003 in the outcomes (LOS, 30-day readmission and mortality) was compared among patients with specific CT imaging status relative to those without.Results Between 2003 and 2015, while the rate of CT increased 3.4% annually, the rate of repeat CTs significantly decreased −1.8% annually and multiple CT showed no change. Compared with 2003 while LOS had a greater decrease in those with any CT, 30-day readmissions had a greater increase among those with any CT, while the probability of mortality remained unchanged between the any CT/no CT groups. A similar result was observed in patients with multiple and repeat CT scanning, except for a significant increase in mortality in the recent years in the repeat CT group.Conclusion The observed pattern of increase in CT utilisation is likely to be activity-based funding policy-driven based on the discordance between LOS and readmissions. Meanwhile, the repeat CT reduction aligns with a more selective strategy of use based on clinical severity. Future research should incorporate in-hospital and out-of-hospital CT to better understand overall CT trends and potential shifts between settings over time. |
| format | Article |
| id | doaj-art-9522ed31103149a79ccdaa22a2389509 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-9522ed31103149a79ccdaa22a23895092025-01-24T20:10:22ZengBMJ Publishing GroupBMJ Open2044-60552022-06-0112610.1136/bmjopen-2021-059242Trend in CT utilisation and its impact on length of stay, readmission and hospital mortality in Western Australia tertiary hospitals: an analysis of linked administrative data 2003–2015Rachael Moorin0Max K Bulsara1Jenny Doust2David Youens3Donald Mcrobbie4John Slavotinek5Thi Ninh Ha6Cameron Wright7Sviatlana Kamarova8Centre for Health Services Research, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, AustraliaInstitute for Health and Rehabilitation Research, University of Notre Dame, Fremantle, Western Australia, AustraliaCentre for Longitudinal and Life Course Research, The University of Queensland, Herston, Queensland, AustraliaCardiovascular Epidemiology Research Centre, School of Population and Global Health, The University of Western Australia, Perth, Western Australia, AustraliaSchool of Physical Sciences, University of Adelaide, Adelaide, South Australia, AustraliaCollege of Medicine and Public Health, Flinders University, Adelaide, South Australia, AustraliaSchool of Population Health, Curtin University, Bentley, Western Australia, AustraliaSchool of Medicine, University of Tasmania, Hobart, Tasmania, AustraliaSchool of Population Health, Curtin University, Perth, Western Australia, AustraliaObjective High use of CT scanning has raised concern due to the potential ionising radiation exposure. This study examined trends of CT during admission to tertiary hospitals and its associations with length of stay (LOS), readmission and mortality.Design Retrospective observational study from 2003 to 2015.Setting West Australian linked administrative records at individual level.Participants 2 375 787 episodes of tertiary hospital admission in adults aged 18+ years.Main outcome measures LOS, 30-day readmissions and mortality stratified by CT use status (any, multiple (CTs to multiple areas during episode), and repeat (repeated CT to the same area)).Methods Multivariable regression models were used to calculate adjusted rate of CT use status. The significance of changes since 2003 in the outcomes (LOS, 30-day readmission and mortality) was compared among patients with specific CT imaging status relative to those without.Results Between 2003 and 2015, while the rate of CT increased 3.4% annually, the rate of repeat CTs significantly decreased −1.8% annually and multiple CT showed no change. Compared with 2003 while LOS had a greater decrease in those with any CT, 30-day readmissions had a greater increase among those with any CT, while the probability of mortality remained unchanged between the any CT/no CT groups. A similar result was observed in patients with multiple and repeat CT scanning, except for a significant increase in mortality in the recent years in the repeat CT group.Conclusion The observed pattern of increase in CT utilisation is likely to be activity-based funding policy-driven based on the discordance between LOS and readmissions. Meanwhile, the repeat CT reduction aligns with a more selective strategy of use based on clinical severity. Future research should incorporate in-hospital and out-of-hospital CT to better understand overall CT trends and potential shifts between settings over time.https://bmjopen.bmj.com/content/12/6/e059242.full |
| spellingShingle | Rachael Moorin Max K Bulsara Jenny Doust David Youens Donald Mcrobbie John Slavotinek Thi Ninh Ha Cameron Wright Sviatlana Kamarova Trend in CT utilisation and its impact on length of stay, readmission and hospital mortality in Western Australia tertiary hospitals: an analysis of linked administrative data 2003–2015 BMJ Open |
| title | Trend in CT utilisation and its impact on length of stay, readmission and hospital mortality in Western Australia tertiary hospitals: an analysis of linked administrative data 2003–2015 |
| title_full | Trend in CT utilisation and its impact on length of stay, readmission and hospital mortality in Western Australia tertiary hospitals: an analysis of linked administrative data 2003–2015 |
| title_fullStr | Trend in CT utilisation and its impact on length of stay, readmission and hospital mortality in Western Australia tertiary hospitals: an analysis of linked administrative data 2003–2015 |
| title_full_unstemmed | Trend in CT utilisation and its impact on length of stay, readmission and hospital mortality in Western Australia tertiary hospitals: an analysis of linked administrative data 2003–2015 |
| title_short | Trend in CT utilisation and its impact on length of stay, readmission and hospital mortality in Western Australia tertiary hospitals: an analysis of linked administrative data 2003–2015 |
| title_sort | trend in ct utilisation and its impact on length of stay readmission and hospital mortality in western australia tertiary hospitals an analysis of linked administrative data 2003 2015 |
| url | https://bmjopen.bmj.com/content/12/6/e059242.full |
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