通过临床算法和预测因素研究改善急诊室疑似急性主动脉综合征的管理。

B. Lumbreras-Fernández , A. Vicente Bártulos , B.M. Fernandez-Felix , J. Corres González , J. Zamora , A. Muriel
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引用次数: 0

摘要

背景和目的:急性主动脉综合征(AAS)是一种罕见且难以诊断的疾病,其临床表现具有很大的变异性。开发一种计算机化算法或临床决策支持系统(CDSS),用于在怀疑AAS时管理和请求急诊科的成像,特别是主动脉计算机断层扫描(CTA),并确定实施该系统的效果。确定与阳性放射学诊断相关的因素,以提高CTA结果的预测能力。材料和方法:在开发和实施基于证据的算法后,我们研究了疑似AAS病例。卡方检验用于分析算法中包含的变量与放射学诊断之间的关联,分为三类:无相关发现、AAS阳性和替代诊断。结果:确定了130项请求;19例(14.6%)有AAS,34例(26.2%)有不同的急性病理。在19名AAS患者中,有15人被划分为高风险,4人被分为中风险。已知主动脉瘤患者发生AAS的概率高3.4倍(P=0.021,95%CI 1.2-9.6),新发主动脉反流杂音患者发生AAS的概率高5.1倍(P=0.019,95%CI 1.3-20.1)。低血压或休克患者发生其他严重急性病理的概率高3.2倍(P=0.02,95%CI 1.2-8.5)急诊科可以帮助优化AAS诊断。已知主动脉瘤和新发主动脉反流的存在显著增加了AAS的概率。需要进一步的研究来建立临床预测规则。
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 the management of suspected acute aortic syndrome in the emergency room through a clinical algorithm and study of predictive factors

Background and objective

Acute aortic syndrome (AAS) is uncommon and difficult to diagnose, with great variability in clinical presentation. To develop a computerized algorithm, or clinical decision support system (CDSS), for managing and requesting imaging in the emergency department, specifically computerized tomography of the aorta (CTA), when there is suspicion of AAS, and to determine the effect of implementing this system. To determine the factors associated with a positive radiological diagnosis that improve the predictive capacity of CTA findings.

Materials and methods

After developing and implementing an evidence-based algorithm, we studied suspected cases of AAS. Chi-squared test was used to analyze the association between the variables included in the algorithm and radiological diagnosis, with 3 categories: no relevant findings, positive for AAS, and alternative diagnoses.

Results

130 requests were identified; 19 (14.6%) had AAS and 34 (26.2%) had a different acute pathology. Of the 19 with AAS, 15 had been stratified as high risk and 4 as intermediate risk. The probability of AAS was 3.4 times higher in patients with known aortic aneurysm (P = .021, 95% CI 1.2–9.6) and 5.1 times higher in patients with a new aortic regurgitation murmur (P = .019, 95% CI 1.3–20.1). The probability of having an alternative severe acute pathology was 3.2 times higher in patients with hypotension or shock (P = .02, 95% CI 1.2–8.5).

Conclusion

The use of a CDSS in the emergency department can help optimize AAS diagnosis. The presence of a known aortic aneurysm and new-onset aortic regurgitation were shown to significantly increase the probability of AAS. Further studies are needed to establish a clinical prediction rule.

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