急诊科急性腹痛影像学要求:一项回顾性横断面研究。

IF 1.3 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Esteban Vasquez, Andrea Torres, Belén Báez, Lía Rodríguez, Diego Cienfuegos, Marcelo Castro
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引用次数: 0

摘要

目的:评估圣地亚哥两家私立医院(2023年)急性腹痛(AAP)的影像学要求(AIR)的适当性是否与更高的诊断率相关,并通过多变量模型探讨预测因素。方法:一项回顾性横断面研究包括年龄≥15岁的AAP患者,他们接受了US、CT或MRI检查。AIR根据ACR适宜性标准进行分类,放射学报告分为确诊或正常。采用多变量逻辑回归模型,结合空气、成像方式和年龄之间的相互作用,确定诊断率的预测因子。结果:共分析了189份影像学研究(75份US, 62份CT, 52份MRI)。总体而言,57.7%的请求是适当的。确诊性发现在66.1%的病例中出现,在适当的请求中出现的频率(84.4%)明显高于不适当的请求(41.3%);p结论:遵守ACR标准与AAP诊断率的提高密切相关,尤其是CT和US。年龄和当地流行病学,包括高胆道疾病患病率,影响了模态的表现。这些发现支持上下文敏感的决策支持工具和前瞻性研究,以完善成像策略并提高急诊护理中的患者安全。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Imaging requests for acute abdominal pain in the emergency department: a retrospective cross-sectional study.

Purpose: To evaluate whether the appropriateness of imaging requests (AIR) for acute abdominal pain (AAP) in two private hospitals in Santiago (2023) was associated with higher diagnostic yield, and to explore predictors through a multivariable model.

Methods: A retrospective cross-sectional study included patients aged ≥ 15 years presenting with AAP who underwent US, CT, or MRI. AIR was classified according to the ACR Appropriateness Criteria, and radiology reports were categorized as confirmatory or normal. A multivariable logistic regression model, incorporating interactions between AIR, imaging modality, and age, was applied to identify predictors of diagnostic yield.

Results: A total of 189 imaging studies were analyzed (75 US, 62 CT, 52 MRI). Overall, 57.7% of requests were appropriate. Confirmatory findings occurred in 66.1% of cases, significantly more frequent in appropriate requests (84.4%) than in inappropriate ones (41.3%; p < 0.01). Inappropriateness reduced diagnostic yield from 78.3% to 17.4% in US and from 91.5% to 25.9% in CT, with no significant difference for MRI (86% vs. 81.3%). Older age was independently associated with higher probabilities of confirmatory findings. Epigastric pain and acute gastroenteritis were disproportionately linked to overuse, while hepatobiliary conditions showed predominantly appropriate use. The model demonstrated high discriminatory performance (AUC = 0.88).

Conclusion: Adherence to ACR criteria was strongly associated with improved diagnostic yield in AAP, particularly for CT and US. Age and local epidemiology, including high biliary disease prevalence, influenced modality performance. These findings support context-sensitive decision-support tools and prospective studies to refine imaging strategies and enhance patient safety in emergency care.

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来源期刊
Emergency Radiology
Emergency Radiology RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
CiteScore
4.60
自引率
4.50%
发文量
98
期刊介绍: To advance and improve the radiologic aspects of emergency careTo establish Emergency Radiology as an area of special interest in the field of diagnostic imagingTo improve methods of education in Emergency RadiologyTo provide, through formal meetings, a mechanism for presentation of scientific papers on various aspects of Emergency Radiology and continuing educationTo promote research in Emergency Radiology by clinical and basic science investigators, including residents and other traineesTo act as the resource body on Emergency Radiology for those interested in emergency patient care Members of the American Society of Emergency Radiology (ASER) receive the Emergency Radiology journal as a benefit of membership!
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