title: A six-year study of diagnostic lower extremity imaging practice patterns and outcomes in the Veterans Affairs health care system.
abstract: BACKGROUND
  The use of diagnostic imaging in the United States continues to increase, while investigations of the clinical implications following testing are lacking. The objectives of the present study are to describe the practice patterns and clinical outcomes that follow lower extremity diagnostic imaging. This is a retrospective cohort study with six years of data (1999 to 2004).
  
  
  METHODS
  The sources of data for the present study were Veterans Affairs Hospital administrative and clinical databases. The study population included 19,209 American veterans who had either contrast-enhanced magnetic resonance angiography (MRA) or digital subtraction angiography (DSA) for the assessment of peripheral artery occlusive disease. Descriptive statistics of the characteristics were provided, as well as adjusted ORs for having interventions or complications following an imaging procedure.
  
  
  RESULTS
  The number of patients initially imaged with a contrast-enhanced MRA increased from 1999 to 2004, while those imaged with DSA decreased. The overall imaging rate remained relatively constant. In the multivariate model adjusted for the risk of complications within 30 days of the initial imaging procedure, the risk of complications following DSA increased 2.29-fold (95% CI 1.60 to 3.30). More patients had an intervention following DSA (DSA 41% versus MRA 23%, P<0.0001) but were also twice as likely to have an intervention with an amputation (adjusted OR 2.36, 95% CI 1.79 to 3.12).
  
  
  CONCLUSIONS
  The present study illustrates the need for prospective evaluation of diagnostic imaging to determine how best to employ screening strategies that will optimize diagnostic imaging and treatment in patients diagnosed with peripheral artery occlusive disease.
authors.affiliation: Veterans Affairs Boston Healthcare System, Massachusetts Veterans Epidemiology Research and Information Center, Veterans Affairs Cooperative Studies Programs. richardscrantonmd@rcn.com
authors.forename: Richard E
authors.initials: RE
authors.lastname: Scranton
authors.forename: Ravi
authors.initials: R
authors.lastname: Dhingra
authors.forename: Elizabeth V
authors.initials: EV
authors.lastname: Lawler
authors.forename: Kent
authors.initials: K
authors.lastname: Yucel
authors.forename: Amy
authors.initials: A
authors.lastname: Guo
authors.forename: Subha P
authors.initials: SP
authors.lastname: Chittamooru
authors.forename: David R
authors.initials: DR
authors.lastname: Gagnon
authors.forename: Joel W
authors.initials: JW
authors.lastname: Hay
authors.forename: John M
authors.initials: JM
authors.lastname: Gaziano