与部脊柱计算机断层扫描过度使用相关的因素
Karl T Chamberlin1, Maureen M Canellas2, Martin A Reznek2
1University of Massachusetts Chan Medical School, Department of Emergency Medicine, Worcester, Massachusetts, karl.chamberlin@umassmemorial.org.
The western journal of emergency medicine
|October 3, 2023
概括
椎脊椎的计算机断层扫描 (CT) 图像在创伤患者中被过度使用. 老年,更高的紧急严重性指数得分,步行到达者和抗凝剂增加了不必要的CT扫描,而学术ED显示的率较低.
科学领域:
- 紧急医疗 紧急医疗
- 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:
- 临床决策规则,如NEXUS C-脊柱规则存在,以指导创伤后的椎脊柱成像.
- 椎脊椎的计算机断层扫描 (CT) 经常在急诊室 (ED) 过度使用,即使在低风险患者中也是如此.
研究的目的:
- 在创伤患者中识别与CT椎成像过度使用相关的因素.
- 开发一个模型,以优化ED CT的利用,并最大限度地减少不必要的测试.
主要方法:
- 对接受CT椎影像创伤的成年患者的回顾性审查.
- 多变量后勤回归分析以识别与不必要的成像相关的因素,基于NEXUS C-脊柱规则.
- 数据收集自一个高等学术ED和三个附属社区ED.
主要成果:
- 在889名分析患者中,42.3%的患者根据NEXUS C-脊柱规则被归类为低风险患者.
- 与不必要的CT成像可能性增加相关的因素包括65岁以上的年龄,紧急严重性指数 (ESI) 分数为2和3,步行到达和抗凝状态.
- 向高等学术ED进行演示与不必要成像的可能性较低有关.
结论:
- 宫脊椎CT成像在创伤患者提交ED时显著过度使用.
- 年龄较大,ESI分数较高,步行状态和抗凝药是过度使用的关键驱动因素.
- 学术EDs显示CT成像的更明智的使用,表明有针对性的干预的潜力.
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