使用基于证据的成像推指南来促进适当的成像:它们都是一样的吗?
Yi Xiang Tay1, Shane J Foley2, Marcus Eh Ong3
1Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland; Radiography Department, Allied Health Division, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
European journal of radiology
|January 26, 2025
概括
对椎X射线的成像转诊指南显示轻微的一致,而CT扫描显示近乎完美的一致. 协调这些指导方针对于提高诊断准确性和患者护理至关重要.
科学领域:
- 放射学和医学成像学 医学成像学
- 临床指南一致性 临床指南一致性
- 紧急医疗 紧急医疗
背景情况:
- 从专业放射学机构采用基于证据的成像推指南的国际采用是常见的.
- 评估这些指导方针的一致性对于一致的临床实践至关重要.
- 评估紧急部门的适当率对于资源优化至关重要.
研究的目的:
- 建立三个主要的成像推指南之间的一致性:ACR (美国放射学学院),ESR (欧洲放射学学会) 和RCR (皇家放射学家学院).
- 检查椎脊柱成像在急诊室的适当率.
- 通过使用像弗莱斯卡帕和科恩卡帕这样的统计指标来分析评级者之间的协议.
主要方法:
- 来自电子病历的452次X光学和153次CT成像转诊的回顾性分析 (10月1日至2022年12月31日).
- 整合初始临床诊断与每个病例的相应临床笔记.
- 对适当性评级的二分化为"有指示"或"没有指示"进行分析.
主要成果:
- 宫脊椎X射线适宜率因使用的指导方针而有显著差异 (13.3%75.2%).
- 在所有三个指导方针中,CT宫脊柱的适当率始终很高 (90.8%).
- 在指导方针中,Fleiss' Kappa发现了对X射线的轻微一致 (κ=0.135) 和对CT的几乎完美的一致 (κ=1.000).
结论:
- 对椎X射线指南达成一致的差异使审计复杂化,影响输出.
- 对于CT椎指导方针的近乎完美的一致性表明,它们在应用上具有更大的一致性.
- 多学科合作提高了CT的适当性,突出了制定协调指南的必要性.
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