title: Advanced imaging use in intensive care units has decreased, resulting in lower charges without negative effects on patient outcomes.
abstract: OBJECTIVE
  There has been both greater recognition and scrutiny of the increased use of advanced imaging. Our aim was to determine whether there has been a change over time in the use of computed tomography (CT), magnetic resonance imaging (MRI), ultrasound (US) modalities in the intensive care units (ICUs).
  
  
  METHODS
  A retrospective review of 75657 admissions to 20 ICUs was conducted. Results were analyzed with multivariate linear, negative binomial, and Poisson regressions. Primary outcomes were rates of use of CT, MRI, and US per 1000 ICU admissions every 6 months. Secondary outcomes were changes in radiology use associated with impacts on mortality, hospital length of stay (LOS), ICU LOS, and hospital charges.
  
  
  RESULTS
  The rate of imaging use decreased by 13.5% between 2007 and 2011 (incidence rate ratio [IRR], 0.982; P < .001). Most of this decrease was by CTs (21.0%; IRR, 0.973; P < .001). Use of MRI decreased by 6.0% (IRR, 0.991; P = .04), whereas US increased by 18.9% (IRR, 1.012; P < .001). The charges associated with imaging decreased by $74 per ICU admission, which would save an estimated $1.2 million in charges during 2011. Decreased imaging was not associated with changes in mortality, hospital, and ICU LOS.
  
  
  CONCLUSIONS
  Advanced imaging use decreased for 5 years in the ICUs, resulting in decreased charges without negative effects on patient outcomes.
authors.affiliation: Departments of Surgery and Emergency Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, MA. Electronic address: Lee.jarone@mgh.harvard.edu.
authors.forename: Jarone
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital and Massachusetts General Hospital, Boston, MA. Electronic address: bgeyer@partners.org.
authors.forename: Brian
authors.initials: B
authors.lastname: Geyer
authors.affiliation: Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, MA. Electronic address: leily.n@aol.com.
authors.forename: Leily
authors.initials: L
authors.lastname: Naraghi
authors.affiliation: Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, MA. Electronic address: Hkaafarani@partners.org.
authors.forename: Haytham M A
authors.initials: HM
authors.lastname: Kaafarani
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, MA. Electronic address: MEikermann@partners.org.
authors.forename: Matthias
authors.initials: M
authors.lastname: Eikermann
authors.affiliation: Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, MA. Electronic address: DYeh2@partners.org.
authors.forename: D Dante
authors.initials: DD
authors.lastname: Yeh
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, MA. Electronic address: ebajwa@partners.org.
authors.forename: Ednan K
authors.initials: EK
authors.lastname: Bajwa
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, MA. Electronic address: jpcobb@partners.org.
authors.forename: J Perren
authors.initials: JP
authors.lastname: Cobb
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA. Electronic address: asraja@partners.org.
authors.forename: Ali S
authors.initials: AS
authors.lastname: Raja
mesh_terms: D017722:Hospital Charges; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000191:economics; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014463:Ultrasonography / Q000706:statistics & numerical data*; D014481:United States
keywords: Computed tomography; Intensive care units; Radiology use; Resource use