减少支气管炎中不必要的胸部X射线:强有力的分析的重要性
Joanna Lawrence1,2,3,4, Harriet Hiscock2,3, Alice Voskoboynik5
1Hospital in the Home, Royal Children's Hospital, Melbourne, Victoria, Australia.
Journal of paediatrics and child health
|April 10, 2024
概括
多方面的干预措施并没有显著减少支气管炎的婴儿的胸部X射线 (CXR). 强大的分析揭示了影响CXR率的潜在趋势,而不是干预措施,突出了低价值护理减少研究中需要谨慎的方法.
科学领域:
- 儿科急救医学 儿科急救医学
- 医疗保健服务研究 医疗服务研究
- 提高质量 提高质量
背景情况:
- 支气管炎是婴儿住院的主要原因,也是减少低价值护理 (LVC) 的目标.
- 胸部X射线 (CXR) 经常用于支气管炎的治疗,但通常被认为是不必要的.
- 结合临床医生教育,家长参与和审计反的多方面的干预措施被用来减少LVC.
研究的目的:
- 评估多方面干预对诊断为支气管炎的婴儿所订购的胸部X射线 (CXR) 率的影响.
- 评估临床医师教育,家长参与和审计反在减少儿科急诊室不必要的CXR利用方面的有效性.
主要方法:
- 一项纵向研究分析了从2016年5月到2023年2月在澳大利亚儿科医院ED的支气管炎的婴儿 (1-12个月) 订购的CXR.
- 使用后勤回归来确定干预对不合理的CXR订单的影响,控制临床,季节和时间变量.
- 分析了10,109名婴儿的数据,其中939名 (9.3%) 接受了CXR,其中69%被认为是不合理的.
主要成果:
- 干预前,不合理的CXR率为7.9%,干预后降至5.4% (P < 0.0001).
- 然而,后勤回归表明,考虑到混变量和时间趋势后,多面干预没有显著的影响 (OR 0.89,95% CI 0.65-1.23).
- 与肺炎重叠的临床特征与CXR决策有关,这表明CXR实用性的持续误解.
结论:
- 尽管出现了明显的前后改善,但在严格分析时,多面干预在减少支气管炎的CXR方面无效.
- 该研究强调了强大的方法和大型电子医疗记录数据集的重要性,以区分干预效应与 LVC 减少举措的潜在时间趋势.
- 关于CXRs在支气管炎的诊断实用性的误解仍然存在,需要在经过测试的多方面的方法之外制定有针对性的策略.
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