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POCUS首次用于结石病:蒙特卡洛模拟说明了节省成本,减少LOS和可预防的辐射
Michael F Barton1, Charles H Brower2, Brenna L Barton3
1Department of Emergency Medicine, University of Chicago Medicine, Chicago, IL, USA.
The American journal of emergency medicine
|September 28, 2023
概括
在符合条件的患者中实施治疗点超声波 (POCUS) 首要方法来评估结石,每年可以节省1650万美元. 这一策略还减少了急诊室停留时间,并将辐射暴露降到最低,防止了潜在的癌症病例.
科学领域:
- 紧急医疗 紧急医疗
- 放射学 放射学是一门学科.
- 医学经济学 医学经济学
背景情况:
- 非对比计算断层扫描 (NCCT) 是ED中结石病的标准.
- 选择明智的指南建议对于特定的低风险患者,不要使用NCCT.
- 需要使用替代诊断策略来优化资源利用和患者安全.
研究的目的:
- 估计在怀疑腎病时,通过对照位超声波 (POCUS) 的第一方法节省的国家成本.
- 量化急诊室 (ED) 停留时间 (LOS) 的减少.
- 评估对可预防的辐射暴露的影响.
主要方法:
- 开发了一个蒙特卡洛模拟,使用ED诊所对结石病的估计.
- 该模型包含了基于明智选择指南的POCUS-first方法的资格标准.
- 在1000多个试验中运行模拟,以估计国家成本节约,LOS减少和辐射暴露.
主要成果:
- 一种POCUS-first方法可以通过避免159,000次NCCT扫描,每年节省大约1650万美元.
- 这一战略预计将ED LOS减少每年166,000个睡眠小时.
- 据估计,每年可以避免约190万人-mSv的辐射暴露,从而有可能预防232例多余的癌症病例和118例癌症死亡.
结论:
- 在符合条件的患者中,POCUS-first对结石的治疗方法可以大幅节省国家成本.
- 显著减少ED LOS和可预防的辐射暴露是可以实现的.
- 进一步的研究应该解决采用障碍,并探索POCUS在其他患者群体中的好处.
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