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Blinick R, Felsen A, Ye K, Lewis A, Kargoli F, Bellin E, Naji L, Haramati LB. Imaging Utilization and Cost of Substance Use in an Urban Academic Medical Center During the Contemporary Opioid Epidemic. Acad Radiol 2024:S1076-6332(24)00091-6. [PMID: 38582686 DOI: 10.1016/j.acra.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/13/2024] [Accepted: 02/13/2024] [Indexed: 04/08/2024]
Abstract
RATIONALE AND OBJECTIVES To determine the recent impact of illicit substance use on imaging utilization and associated costs. METHODS Retrospective study from an inner city urban multi-site academic medical center. Institutional Review Board (IRB) approval was obtained with a waiver of informed consent. A substance use cohort comprised patients 12 years old presenting to the Emergency Department (ED) January 2017 to June 2019 with a positive urine toxicology and an ICD code associated with substance use. The comparison cohort was randomly selected from a group of ED patients who presented with no or negative urine toxicology and no documented substance use ICD code. Data extracted from the EMR included demographics, number and type of imaging studies, Charlson comorbidity index, and in-hospital mortality during the study period. RESULTS The substance use and comparison cohorts comprised 3191 and 3200 patients, respectively. The substance use cohort was older on average (mean age 45.67 ± 14.88 vs 43.91 ± 20.57 years), more often male (63% [2026/3191] vs. 39% [1255/3200]) and had a mean Charlson score 88% higher than the comparison cohort (3.33 vs 1.78). The majority of both cohorts were ethnic minorities (<10% white). The substance use cohort had significantly more imaging vs the comparison cohort, total 36,413 (mean 11.41 exams/patient) vs total 12,399 (mean 3.87 exams/patient), p < 0.0001, and was higher for all modalities except mammography. Average imaging costs per patient were nearly 300% higher for the substance use vs comparison cohort, ($1287.18 vs. $434.70). CONCLUSION Imaging utilization and associated costs were substantially higher for patients with a positive urine toxicology and substance use related ICD codes compared to the broader ED population in an underserved urban population.
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Affiliation(s)
- Rachel Blinick
- Montefiore Medical Center, Bronx, New York 10467, USA; Albert Einstein College of Medicine, Bronx, New York, 10461, USA.
| | - Amanda Felsen
- Albert Einstein College of Medicine, Bronx, New York, 10461, USA; Department of Radiology, Columbia University Medical Center, New York, New York, 10032, USA
| | - Kenny Ye
- Albert Einstein College of Medicine, Bronx, New York, 10461, USA
| | - Ariel Lewis
- Albert Einstein College of Medicine, Bronx, New York, 10461, USA; Department of Radiology, Jacobi Medical Center, Bronx, New York 10461, USA
| | - Faraj Kargoli
- Montefiore Medical Center, Bronx, New York 10467, USA
| | - Eran Bellin
- Montefiore Medical Center, Bronx, New York 10467, USA; Albert Einstein College of Medicine, Bronx, New York, 10461, USA
| | - Leen Naji
- Montefiore Medical Center, Bronx, New York 10467, USA; Albert Einstein College of Medicine, Bronx, New York, 10461, USA
| | - Linda B Haramati
- Montefiore Medical Center, Bronx, New York 10467, USA; Albert Einstein College of Medicine, Bronx, New York, 10461, USA; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
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Blinick R, Chaya N, Zalta B, Haramati LB, Shmukler A. Cracking the Opium Den: Cardiothoracic Manifestations of Drug Abuse. J Thorac Imaging 2021; 36:W16-W31. [PMID: 32102017 DOI: 10.1097/rti.0000000000000488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Recreational drug use is increasing worldwide, with emergency room visits and total deaths from drug overdose rising in recent years. Complications from prescription and recreational drug use may result from the biochemical effects of the drugs themselves, impurities mixed with substances, or from causes related to the method of drug administration. The presentation of drug overdose may be complex due to multisubstance abuse, including cigarette smoking and alcoholism, and can impact any organ system. Patients may present without history, and radiologists may be the first clinicians to suggest the diagnosis. We aim to explore the cardiothoracic manifestations of drug abuse and their multimodality imaging manifestations.
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Affiliation(s)
| | - Nathan Chaya
- Montefiore Medical Center, Bronx
- Staten Island University Hospital, Staten Island, NY
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