上肢外科医生对成像的建议不符合成像适当性指南
Shyam S Ramachandran1,2, David Ring2, Tom J Crijns2
1Texas A&M Health Science Center, School of Medicine, Dallas, Texas, United States.
Journal of hand and microsurgery
|June 10, 2024
概括
图像适用性指南显示,上肢外科医生的临床实用性有限. 对于高级成像 (MRI/CT) 的专家建议有很大的差异,这表明需要改进决策策略.
科学领域:
- 肌肉骨成像技术 肌肉骨成像技术
- 医疗决策的制定能力
- 医疗服务研究 医疗服务研究
背景情况:
- 越来越多地使用像MRI和CT这样的先进成像技术,引发了人们对过度使用的担忧.
- 图像适当性指南旨在标准化基于证据的决策,减少不必要的扫描.
- 这项研究将专家对肌肉骨疾病的先进成像技术的使用与已建立的适当性建议进行比较.
研究的目的:
- 评估已发表的成像适当性指南与专家外科医生对上肢肌肉骨疾病的建议之间的一致性.
- 评估当前指导方针在临床实践中指导先进成像决策的有用性.
主要方法:
- 整理了15个用于上肢高级成像的成像指南.
- 对来自变异科学小组 (SOVG) 的108名外科医生进行了调查,调查了11种常见的上肢疾病情景.
- 通过使用费舍尔的精确测试和评估与弗莱斯公司的观察者间一致性,将指南建议与外科医生建议进行了比较.
主要成果:
- 大多数指南建议先进成像 (MRI/CT),而大多数外科医生对11种情景不建议.
- 在外科医生和指南建议之间没有发现显著的相关性 (ρ = 0.28,p = 0.40).
- 在外科医生之间观察到一些关于成像建议的微弱观察者间一致性 (kappa = 0.17).
结论:
- 目前对上肢的成像适当性指南似乎过于宽容,为外科医生提供有限的临床实用性.
- 在高级成像推中,外科医生之间存在显著的差异,突出了潜在的不可靠性.
- 需要制定策略,使患者的成像决策与他们的价值观保持一致,并减轻误解或外科医生习惯的影响.
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