Association between radiologic incidental findings and resource utilization in patients admitted with chest pain in an urban medical center
BACKGROUND
Increasing use of testing among hospitalized patients has resulted in an increase in radiologic incidental findings (IFs), which challenge the provision of high-value care in the hospital setting.
OBJECTIVE
To understand impact of radiologic incidental findings on resource utilization in patients hospitalized with chest pain.
DESIGN
Retrospective observational cross sectional study.
SETTING
Academic medical center.
PARTICIPANTS
Adult patients hospitalized with principal diagnosis of chest pain.
MEASUREMENTS
Demographic, imaging, and length of stay (LOS) data were abstracted from the medical charts. We used multiple logistic regression to evaluate factors associated with radiologic IFs and negative binomial regression to evaluate the association between radiologic IFs and LOS.
RESULTS
1811 consecutive admissions with chest pain were analyzed retrospectively over a period of 24 months; 376 patients were included in the study after exclusion criteria were applied and readmissions removed. Of these, 197 patients (52%) had 364 new radiologic IFs on imaging; most IFs were of minor (50%) or moderate clinical significance (42%), with only 7% of major significance. Odds of finding radiologic IFs increased with age (adjusted odds ratio, 1.04; 95% confidence interval [CI], 1.01-1.06) and was associated with a 26% increase in LOS (adjusted incidence rate ratio, 1.26; 95% CI, 1.07-1.49).
CONCLUSION
Radiologic IFs were very common among patients hospitalized with chest pain of suspected cardiac origin and independently associated with an increase in the LOS. Interventions to address radiologic IFs may reduce LOS and, thereby, support high-value care. Journal of Hospital Medicine 2017;12:323-328. © 2017 Society of Hospital Medicine
© 2017 Society of Hospital Medicine
CONCLUSION
Incidental findings are both clinical and financial challenges to the medical field. This study attempted to shed light on impact of radiologic IFs on care and resource utilization in patients admitted with chest pain of suspected cardiac origin. The positive association between radiologic IFs and length of hospital stay implies that the presence of IFs is associated with increase in LOS and indirectly a likely increase in overall healthcare expenditure. Given the high incidence of radiologic IFs, assuming that these will be present on radiologic tests, should be more a norm than an exception. Providers should know that radiologic testing, especially CT, is associated with detection of IFs.16 By avoiding inappropriate ordering of imaging, the issue of IFs could be mitigated.
While radiologists have recommendations about necessary follow-up for some IFs,7 no clear follow-up guidelines exist for most IFs arising in hospitalized patients. Further prospective and cost analysis studies are needed to assess the overall impact of IFs on other hospitalized patient populations and on the healthcare system in general.
Disclosure
The authors report no conflicts of interest.
