减少小创伤头部伤害儿童成像干预措施:系统性审查
Nick Lesyk1, Scott W Kirkland1, Cristina Villa-Roel1
1Department of Emergency Medicine, Faculty of Medicine & Dentistry, College of Health Sciences.
Pediatrics
|November 1, 2024
概括
实施包括PECARN规则在内的多方面的干预措施,显著减少了轻微创伤性脑损伤儿童的头部CT扫描. 高成像性ED患者的复杂策略显示,不必要的成像率下降最为显著.
科学领域:
- 儿科急救医学 儿科急救医学
- 放射学 放射学是一门学科.
- 临床干预 临床干预
背景情况:
- 减少对小创伤性脑损伤 (mTBIs) 的儿童进行不必要的计算机断层扫描 (CT) 头部成像,向急诊室 (ED) 呈现,这是一个关键的医疗保健目标.
- 系统审查对于评估旨在优化诊断成像实践的干预措施的有效性至关重要.
研究的目的:
- 系统地审查和综合有关旨在减少儿童患者头部成像利用的干预措施的证据.
- 在现实世界的临床环境中确定影响这些干预措施成功的因素.
主要方法:
- 对八个电子数据库和灰色文献进行了全面的搜索,以确定相关的比较研究.
- 两个独立的审查员选了研究,评估了质量,并提取了数据,使用元回归来分析成像减少的预测因素.
- 分析了利用前后设计和多方面的干预措施的研究,特别是那些结合儿科紧急护理应用研究网络 (PECARN) 规则的研究.
主要成果:
- 包括28项研究,其中大多数采用前后设计和多方面的干预措施 (中位数为3个组成部分).
- 儿科紧急护理应用研究网络 (PECARN) 规则是最经常实施的干预措施 (71%).
- 结合PECARN规则的多面干预表明,头部CT成像显著减少 (相对风险=0.73),基线成像率更高,干预组件更多,与更大的下降相关.
结论:
- 实施复杂的干预措施,特别是那些包括PECARN决策规则在高基线CT订购EDs中的干预措施,有效地减少了mTBIs儿童的头部成像.
- 这些策略,特别是多方面的策略,可以使CT订单的中位数减少27%.
- 需要进一步的研究,以阐明导致成功实施和持续减少成像的具体因素.
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