コンピュータートモグラフィ・アニオグラフィと,緊急治療室での胃腸出血の収量
Siona Prasad1,2, C Michael Hood1,2,3, Cameron Young1,2
1Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Mass General Brigham, Boston, Massachusetts.
JAMA network open
|August 29, 2025
まとめ
緊急治療室 (ED) での胃腸出血 (GIB) のためのコンピュータ断層動脈造影 (CTA) の使用は,2017年から2023年にかけて著しく増加した. しかし,この期間中に,活発な出血を検出するためのCTAの診断出力は大幅に低下しました.
科学分野:
- 放射線科
- 胃腸内科
- 緊急 医療
背景:
- コンピュータートモグラフィ・アニオグラフィ (CTA) などの高度なイメージングは,緊急治療室 (ED) でますます利用されています.
- CTAは急性胃腸出血 (GIB) の診断に推奨されているが,そのエスカレートした使用は,活発な出血の検出を比例して向上させない.
- 画像処理の過剰利用は 医療費の増加,ED効率の低下,患者混雑に寄与しています
研究 の 目的:
- EDの設定内のGIBの疑いに対するCTA利用の傾向を分析する.
- GIBのCTAの診断値の変化を時間とともに評価する.
主な方法:
- 都市学術医療センターで2017年1月から2023年12月まで遡及的なコホート研究が行われました.
- この研究では,EDで疑われるGIBのために腹部および骨盤CTAを受けた成人患者が対象でした.
- 主要なアウトカムには,すべてのEDCTスキャンの中でGIBに関連するCTAの年間量と割合が含まれ,次要のアウトカムはテスト陽性比率 (診断収量) でした.
主要な成果:
- GIBに関連するCTAの数は2017年の0.09%から2023年の0.65%に増加しました.
- 診断率 (検査陽性比) は2017年の20.0%から2023年の6.3%に減少した.
- 多変量分析により,年齢の上昇は陽性CTAの確率の上昇と関連しており,カレンダー年数やがんの進行は確率の低下と関連していることが示された.
結論:
- EDにおけるGIBの疑いに対するCTAの利用は顕著に増加したが,活発な出血を検出する効果は低下した.
- この傾向は,CTAの診断上の利点と関連するコスト,放射線被曝,および運用上の影響の間の慎重なバランスを必要とします.
- GIBのED評価においてCTAの使用を最適化するために,エビデンスに基づく順序付けガイドラインと臨床決定支援ツールが不可欠です.
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