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肺栓塞管理审计和机器学习分析瑞士教学医院延迟抗凝剂的分析
Cedrine Kueng1,2, Maria Boesing1,2, Stéphanie Giezendanner1,3
1University Institute of Internal Medicine, Cantonal Hospital Baselland, CH-4410 Liestal, Switzerland.
Journal of clinical medicine
|October 26, 2024
概括
这次对急性肺栓塞 (PE) 诊断的审计发现,57%的病例遵守了指导方针,而抗凝剂的延迟与诊断时间和患者呈现有关. 在预试验概率评估和风险分层方面需要改进.
科学领域:
- 医学诊断 医学诊断 医学诊断
- 临床审计 临床审计
- 肺部医学 肺部医学
背景情况:
- 诊断急性肺栓塞 (PE) 面临各种症状和差异诊断的挑战.
- 在避免不必要的测试的同时平衡基本检查对于有效的PE管理至关重要.
- 这项研究以后审计了瑞士医院的PE诊断和治疗,以评估遵守指南并确定推迟抗凝剂的因素.
研究的目的:
- 评估在急性PE诊断和治疗中遵守当前指导方针.
- 确定导致PE患者抗凝血启动延迟的临床因素.
- 确定PE管理协议中需要改进的领域.
主要方法:
- 在2018年11月至2020年10月期间住院的成人PE患者的回顾性观察队列研究.
- 纳入标准:诊断是在急诊室 (ED) 抵达后12小时内进行的.
- 拉索回归用于识别与延迟抗凝启动相关的因素.
主要成果:
- 包括197名患者; 57%的诊断工作符合指导方针.
- 预测的概率 (威尔斯/日内瓦得分) 记录在只有3%; PESI得分在21%.
- 截至CT扫描的平均时间:120分钟;截至抗凝剂的平均时间:193分钟. 延迟的因素包括早上的ED到来, jugular 静脉膨胀,软弱/疲劳,以及延长的CT扫描时间.
结论:
- 研究医院的PE管理通常符合高标准,但需要改进.
- 需要改进的领域包括预先测试概率评估,风险分层 (PESI分数),D-二次体的使用,腿部超声记录和抗凝血持续时间的清晰度.
- 优化诊断工作流程和遵守风险评估工具可以改善PE患者的及时抗凝药.
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