及时报告手术前CT扫描是否会影响紧急腹腔切除术后患者的结果?
S Ikram1, N Mirtorabi1, D Ali1
1University Hospitals Birmingham NHS Foundation Trust, UK.
Annals of the Royal College of Surgeons of England
|June 13, 2024
概括
对手术前CT扫描报告准则的遵守率很低,特别是在关键病例中. 当调整为关键风险因素时,这种时间遵守并没有显著影响患者的死亡率,这表明选择偏差.
科学领域:
- 紧急医疗 紧急医疗
- 放射学 放射学是一门学科.
- 外科手术的结果
背景情况:
- 及时的手术前计算机断层扫描 (CT) 扫描对于紧急腹腔切除术患者至关重要.
- 英国的指导方针建议CT扫描报告"关键"病例在1小时内,而"紧急"病例在12小时内.
研究的目的:
- 调查遵守手术前CT扫描报告时间指南与患者死亡率之间的关联.
- 确定影响遵守这些指南的因素.
主要方法:
- 在2014-2021年国家紧急拉皮切除术审计 (NELA) 中对1299名患者进行的观察研究.
- 多变量逻辑回归分析了遵守指南,死亡率,年龄,性别,入院时间,ASA得分和NELA死亡风险.
主要成果:
- 只有28%的CT扫描符合时间指南;关键扫描不太可能遵守.
- 单变量分析表明,随着遵守,死亡率降低,但这在多变量模型中没有显著意义.
- 年龄,ASA得分和NELA死亡风险仍然是死亡率的重要预测因素.
结论:
- 少数患者及时收到手术前CT报告,特别是关键病例.
- 当调整为风险因素时,遵守时间指南并没有显著影响死亡率.
- 观察到的准则遵守和结果之间的关联可能是由于选择偏差而不是因果关系.
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