计算机断层扫描 肺血管图谱 订购,遵守决策规则和在急诊室的产量:一项观察性研究
Saransh Kumar Saini1,2,3, Zain Saleem Khan1,2,3, Victor Do4,5
1Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.
Emergency medicine Australasia : EMA
|May 3, 2024
概括
坚持肺栓塞 (PE) 诊断的临床决策工具可以减少不必要的CT肺血管图像 (CTPA). 前测试概率 (PTP) 方法显示,它有可能预防许多CTPA,因此需要进一步研究.
科学领域:
- 紧急医疗 紧急医疗
- 放射学 放射学是指放射学
- 临床决策支持 临床决策支持
背景情况:
- 肺栓塞 (PE) 诊断通常依赖于CT肺血管造影 (CTPA).
- 基于证据的临床决策工具可以优化CTPA的利用.
- 昆士兰卫生部有一个可疑的PE诊断途径,涉及威尔斯分数,PE排除标准 (PERC) 和D-二次元解释.
研究的目的:
- 为了评估对昆士兰卫生所怀疑的PE诊断途径的遵守.
- 评估威尔斯分数,PERC和年龄调整的D-二次数解释的有效性.
- 为了比较年龄调整的D-二分体与基于新型前测试概率 (PTP) 的模型.
主要方法:
- 在2023年1月1日至4月30日期间,在第三级城市急诊室订购的573个CTPA的回顾性分析.
- 数据收集包括临床变量,D-二次元结果和CTPA结果.
- 描述性分析评估了D-二次元解释工具的准则遵守和性能,包括基于PTP的模型,具有特定的D-二次元切线.
主要成果:
- 对CTPA的整体诊断收益率为12.4%.
- 韦尔斯分数分层显示诊断收益率为4.0% (低),18.5% (中等) 和41% (高风险).
- 根据PERC规则,可以排除25名低PTP患者. 根据年龄调整的D-二分体解释可能防止了26个CTPA (没有虚假阴性),而PTP方法可能防止了128个CTPA (四个虚假阴性).
结论:
- 改善对临床决策工具的遵守,可以减少不必要的CTPA订单,并提高诊断产量.
- 经年龄调整的D-二次体解释显示了良好的灵敏度.
- 新的PTP方法显示出希望,但需要进一步的前性验证.
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