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Cardiac computed tomography (CT) scanning is an advanced cardiac imaging technique that utilizes CT technology, with or without intravenous (IV) contrast, to produce accurate cross-sectional virtual slices of specific areas of the heart, coronary circulation, and major blood vessels such as the aorta, pulmonary veins, and arteries. The computer processes these slices to generate three-dimensional images. Multidetector CT (MDCT) is a rapid form of CT scanning that captures multiple slices...
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在急诊室的胃肠道出血的计算机断层扫描和产量

Siona Prasad1,2, C Michael Hood1,2,3, Cameron Young1,2

  • 1Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Mass General Brigham, Boston, Massachusetts.

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概括

计算机断层扫描 (CTA) 用于胃肠道出血 (GIB) 在急诊室 (ED) 从2017年到2023年显著增加. 然而,CTA用于检测活跃出血的诊断产量在此期间大幅下降.

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科学领域:

  • 放射学
  • 胃肠病学
  • 紧急医疗

背景情况:

  • 计算机断层扫描 (CTA) 等先进的成像技术越来越多地被用于急诊室.
  • 虽然CTA是推用于诊断急性胃肠道出血 (GIB),但其不断使用可能不会相应地提高活跃出血的检测.
  • 过度使用成像有助于增加医疗费用,降低ED效率和患者拥挤.

研究的目的:

  • 在ED环境中分析疑似GIB的CTA利用趋势.
  • 评估随着时间的推移对GIB的CTA诊断产量的变化.

主要方法:

  • 从2017年1月到2023年12月,在一个城市学术医疗中心进行了回顾性队列研究.
  • 这项研究包括了成年患者,他们因疑似GIB而接受腹部和骨盆CTA治疗.
  • 主要结果包括所有EDCT扫描中的GIB相关CTA年数量和比例,次要结果是测试阳性比例 (诊断产量).

主要成果:

  • 与GIB相关的CTA数量从2017年的0.09%上升到2023年的0.65%.
  • 诊断产量 (检测阳性比例) 从2017年的20.0%降至2023年的6.3%.
  • 多变量分析表明,年龄增加与阳性CTA的几率较高有关,而较新的日历年和活跃的癌症则与较低的几率有关.

结论:

  • 在ED中疑似GIB的CTA利用显著增加,而其在检测活跃出血方面的有效性却有所下降.
  • 这种趋势需要在CTA的诊断效益与相关成本,辐射暴露和运营影响之间进行谨慎的平衡.
  • 基于证据的订购指南和临床决策支持工具对于优化CTA在GIBED评估中的使用至关重要.