CT 肺血管造影临床预检概率工具：对急诊科使用率的影响。

IF 4 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of the American College of Radiology Pub Date : 2024-12-01 DOI:10.1016/j.jacr.2024.07.024

Rachel P. Rosovsky MD, MPH , Mark Isabelle BA , Nooshin Abbasi MD, MPH , Nicole Vetrano MHA , Sanjay Saini MD , Sayon Dutta MD, MPH , David Lucier MD , Amita Sharma MD , Andetta Hunsaker MD , Stanley Hochberg MD , Ali S. Raja MD, MPH, MBA , Ramin Khorasani MD, MPH , Ronilda Lacson MD, PhD

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引用次数: 0

摘要

目的：目前，急诊科（ED）中用于评估急性肺栓塞（PE）的计算机断层扫描肺血管造影（CTPA）被过度使用，且收效甚微。本研究的目的是评估循证临床决策支持（CDS）工具的影响，旨在优化 CTPA 在评估 PE 时的合理使用：研究在一家大型医疗系统的急诊室进行，包括 9 家学术医院和社区医院。主要结果是使用率（进行 CTPA 的次数/急诊室就诊次数）的百分比差异，次要结果是产量（急性 PE CTPA 阳性的百分比），比较全系统实施 CDS 前 12 个月（6/1/2021-5/31/2022）与实施 CDS 后 12 个月（6/1/2022-5/31/2023）的情况。使用逻辑回归进行单变量和多变量分析，以评估与急性 PE 诊断相关的因素。统计过程控制（SPC）图表用于评估利用率和产量的月度趋势：在 931,677 次急诊就诊中，为 24,675 名患者进行了 28,101 次 CTPA。干预前，455,038 人次中进行了 14,825 次 CTPA（3.26%）；干预后，476,639 人次中进行了 13,276 次 CTPA（2.79%），CTPA 使用率相对下降了 14.51%（秩和平方，p 讨论：实施基于验证决策规则的 CDS 可显著减少 CTPA 的使用。这种变化是立竿见影的，并在干预后持续了 12 个月。

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CT Pulmonary Angiogram Clinical Pretest Probability Tool: Impact on Emergency Department Utilization

Objective

Currently, CT pulmonary angiogram (CTPA) for evaluating acute pulmonary embolism (PE) in emergency departments (EDs) is overused and with low yields. The goal of this study is to assess the impact of an evidence-based clinical decision support (CDS) tool, aimed at optimizing appropriate use of CTPA for evaluating PE.

Methods

The study was performed at EDs in a large health care system and included nine academic and community hospitals. The primary outcome was the percent difference in utilization (number of CTPAs performed per number of ED visits) and secondary outcome was yield (percentage of CTPAs positive for acute PE), comparing 12 months before (June 1, 2021, to May 31, 2022) versus 12 months after (June 1, 2022, to May 31, 2023) a systemwide implementation of the CDS. Univariate and multivariable analyses using logistic regression were performed to assess factors associated with diagnosis of acute PE. Statistical process control charts were used to assess monthly trends in utilization and yield.

Results

Among 931,677 visits to EDs, 28,101 CTPAs were performed on 24,675 patients. In all, 14,825 CTPAs were performed among 455,038 visits (3.26%) pre-intervention and 13,276 among 476,639 visits (2.79%) postintervention, a 14.51% relative decrease in CTPA utilization (χ², P < .001). CTPA yield remained unchanged (1,371 of 14,825 = 9.25% pre- versus 1,184 of 13,276 = 8.92% postintervention; χ², P = .34). Patients with coronavirus disease of 2019 diagnosis before CTPA had higher probability of acute PE. Statistical process control charts demonstrated seasonal variation in utilization (Friedman test, P = .047).

Discussion

Implementing a CDS based on validated decision rules was associated with a significant reduction in CTPA utilization. The change was immediate and sustained for 12 months postintervention.

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来源期刊

Journal of the American College of Radiology RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-

CiteScore

6.30

自引率

8.90%

发文量

312

审稿时长

34 days

期刊介绍： The official journal of the American College of Radiology, JACR informs its readers of timely, pertinent, and important topics affecting the practice of diagnostic radiologists, interventional radiologists, medical physicists, and radiation oncologists. In so doing, JACR improves their practices and helps optimize their role in the health care system. By providing a forum for informative, well-written articles on health policy, clinical practice, practice management, data science, and education, JACR engages readers in a dialogue that ultimately benefits patient care.