计算机断层扫描在轻度头部创伤儿童的管理中的利用
Ernest Leva1, Minh-Tu Do1, Rachael Grieco1
1Department of Pediatric, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08903-0019, USA.
安全CT成像计划成功减少了新泽西州医院中轻度创伤性脑损伤 (mTBI) 的儿童的计算机断层扫描 (CT) 扫描. 这一倡议促进了基于证据的指导方针,导致CT使用率大幅下降.
科学领域:
- 儿科急救医学 儿科急救医学
- 放射学 放射学是一门学科.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 儿童轻度创伤性脑损伤 (mTBI) 往往导致不必要的计算机断层扫描 (CT) 扫描.
- 儿科紧急护理应用研究网络 (PECARN) 提供基于证据的指导方针,以减少儿科mTBI中的CT使用.
- 安全CT成像合作倡议旨在在新泽西州的医院实施PECARN规则.
研究的目的:
- 评估在安全CT成像合作倡议之前和之后儿童mTBI的CT使用趋势.
- 为了比较儿童医院和普通医院之间的CT利用率.
- 评估该倡议对遵守PECARN指南的影响.
主要方法:
- 对新泽西州10家儿童医院和59家普通医院的行政数据库进行了回顾性分析.
- 在三个时期的CT使用率的比较:基线 (2014-2015),计划启动 (2016) 和后实施 (2017-2019).
- 时间序列建模和回归分析,以确定CT缩小的趋势和预测因素.
主要成果:
- 与一般医院相比,儿童医院的CT使用率在儿童医院 (19.2%至14.2%) 始终较低 (36.7%至21.0%).
- 该计划表明,在四年内,儿童mTBI患者的CT减少趋势显著,在第一年减少最多.
- 较高的基线CT使用率预测了较大的CT减少,独立于医院类型或患者数量.
结论:
- 安全CT成像协作倡议有效地减少了新泽西州医院儿童mTBI的CT利用率.
- 基于证据的指导方针的实施可以显著减少儿科紧急护理中不必要的成像.
- 医院类型和基线CT使用是影响成像减少计划成功的关键因素.
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