改进儿科 CT 的使用和合理性:单中心经验。

BJR open Pub Date : 2024-08-05 eCollection Date: 2024-01-01 DOI:10.1093/bjro/tzae020
Mariliis Tiidermann, Triin Pihlakas, Juhan Saaring, Janelle Märs, Jaanika Aasmäe, Kristiina Langemets, Mare Lintrop, Pille Kool, Pilvi Ilves
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引用次数: 0

摘要

目的分析过去十年中儿科(小于16岁)CT使用的变化,并评估一家三级教学医院CT检查的适当性:前瞻性地收集了2022年290例儿科CT的数据,并与2017年(358例)和2012年(538例)的数据进行了比较。根据医学影像转诊指南评估了CT的合理性,并计算了适当率:10年间,儿科CT减少了39.4%,而总体CT增加了27.6%。儿科CT占总体CT的比例从2012年的2.5%降至2022年的1.1%(P P = .0003)、慢性头痛(P P = .037)、脑积水(P = .0078)、胸部肿瘤(P = .0005)和全身肿瘤(P = .0041)。CT的总体适宜性从2017年的73.1%提高到2022年的79.0%(P = .0049)。15.4%的病例认为没有必要进行放射检查,8.7%的病例认为其他方式更合适。头颈部血管造影(100%)和胸部(96%)的适宜率最高,颈部(66%)和头部(67%)的适宜率最低:结论:通过定期的教育干预、增加磁共振成像的可及性以及在检查前评估所需 CT 的适当性,可以改善 CT 扫描的合理性。需要采取干预措施以更有效地执行转诊指南:改进的重点应放在头部和颈椎创伤的 CT 检查上,因为在儿科人群中,不适当的 CT 检查申请占大多数。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Improvement in paediatric CT use and justification: a single-centre experience.

Objectives: To analyse changes in the use of paediatric (≤16 years) CT over the past decade and to evaluate the appropriateness of CT examinations at a tertiary teaching hospital.

Methods: Data from 290 paediatric CTs were prospectively collected in 2022 and compared with data from 2017 (358 cases) and 2012 (538 cases). The justification of CTs was evaluated with regard to medical imaging referral guidelines and appropriateness rates were calculated.

Results: Paediatric CTs decreased 39.4% over the 10 years, contrasting with a 27.6% increase in overall CTs. Paediatric CTs as the share of overall CTs dropped from 2.5% in 2012 to 1.1% in 2022 (P < .0001), with a concurrent rise in paediatric MRIs (P < .0001). Notable reductions in CT use occurred for head trauma (P = .0003), chronic headache (P < .0001), epilepsy (P = .037), hydrocephalus (P = .0078), chest tumour (P = .0005), and whole-body tumour (P = .0041). The overall appropriateness of CTs improved from 73.1% in 2017 to 79.0% in 2022 (P = .0049). In 15.4% of the cases, no radiological examination was deemed necessary, and in 8.7% of the cases, another modality was more appropriate. Appropriateness rates were the highest for the head and neck angiography (100%) and the chest (96%) and the lowest for the neck (66%) and the head (67%).

Conclusions: Justification of CT scans can be improved by regular educational interventions, increasing MRI accessibility, and evaluating the appropriateness of the requested CT before the examination. Interventions for a more effective implementation of referral guidelines are needed.

Advances in knowledge: The focus for improvement should be CTs for head and cervical spine trauma, accounting for the majority of inappropriate requests in the paediatric population.

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