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JAMA Pediatr:儿科急诊中CT使用率变化研究

2020-08-11 MedSci原创 MedSci原创

近10年来,随着超声和MRI的普遍使用,儿科急诊中CT的使用逐渐下降,但不同机构间非辐射成像方式与CT使用率间的差异显著,建立相应的临床实践标准十分必要

随着人们对CT辐射风险认识的不断提高,急诊科(EDs)中CT代替方案不断涌现。近日研究人员就美国儿科急诊中CT代替方案使用情况进行了考察。
 
研究人员收集2009年1月1日到2018年12月31日期间,18岁以下儿童儿科急诊数据,总计26082062次急诊就诊,研究的主要终点为患儿接受CT、超声和磁共振成像(MRI)率变化,次要终点为入院率、3天内ED再就诊和ED住院时间
 
在10年的研究期间,共有986806名儿童(平均年龄为5.5岁, 53.1%为男性,35.6%名非西班牙裔白人)在32个美国儿科EDs就诊26082062次,在1919283次就诊中使用了1次或更多的除CT外的高级影像学检查(7.4%)。儿科ED患者接受任何高级成像的比例从2009年的6.4%上升到2018年的8.7%。ED患者接受CT检查的比例从3.9%下降到2.9%,超声检查从2.5%增加到5.8%,MRI检查从0.3%增加到0.6%。CT检查比率下降最多的疾病类型为脑震荡(-23.0%)、阑尾切除术(-14.9%)、心室分流术(-13.3%)和头痛(-12.4%)。接受非辐射成像的相关因素包括腹部疼痛和阑尾切除术的超声检查和心室分流术的MRI检查,但不同机构间的差异显著。总的来说,ED住院时间没有改变,住院率和3天ED再就诊率在研究期间下降。
 
近10年来,随着超声和MRI的普遍使用,儿科急诊中CT的使用逐渐下降,但不同机构间非辐射成像方式与CT使用率间的差异显著,建立相应的临床实践标准十分必要。
 
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    2021-03-14 feather89
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    2021-02-02 科研科研科研

    CT在儿童中使用率下降

    0

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    2020-12-27 oo902

    CT使用率

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1639576, encodeId=19f316395e6a1, content=<a href='/topic/show?id=afda591646' target=_blank style='color:#2F92EE;'>#DIA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5916, encryptionId=afda591646, topicName=DIA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=987022654425, createdName=ms9608593228839890, createdTime=Sat Aug 15 12:48:58 CST 2020, time=2020-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1728628, encodeId=69121e2862849, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Sun Mar 14 00:48:58 CST 2021, time=2021-03-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922122, encodeId=2c4d92212223, content=CT在儿童中使用率下降, beContent=null, objectType=article, channel=null, level=null, likeNumber=140, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210110/e6124a4b19bc40ce8afaae096d21126b/dd778ac260c9416eb87e7d08139507f5.jpg, createdBy=4d2f5079605, createdName=科研科研科研, createdTime=Tue Feb 02 09:26:19 CST 2021, time=2021-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=911337, encodeId=3a3591133e3f, content=CT使用率, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=a37a1710612, createdName=oo902, createdTime=Sun Dec 27 19:37:19 CST 2020, time=2020-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=811251, encodeId=3996811251b0, content=不同情况选用不同的检查手段 急诊CT使用率应该是和疾病以及其他辅助检查能力相关, beContent=null, objectType=article, channel=null, level=null, likeNumber=138, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200809/b24f1ce03127421aaee1ade77b85a826/d600ec61f5e943a3b4229aa5660a3ad3.jpg, createdBy=85e15409722, createdName=Slie, createdTime=Thu Aug 20 07:09:45 CST 2020, time=2020-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615919, encodeId=364f161591999, content=<a href='/topic/show?id=158826812c4' target=_blank style='color:#2F92EE;'>#使用率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26812, encryptionId=158826812c4, topicName=使用率)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8dee19693687, createdName=ms3830150583600765, createdTime=Thu Aug 13 09:48:58 CST 2020, time=2020-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036215, encodeId=a4fc103621514, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Tue Aug 11 21:48:58 CST 2020, time=2020-08-11, status=1, ipAttribution=)]
    2020-08-20 Slie

    不同情况选用不同的检查手段 急诊CT使用率应该是和疾病以及其他辅助检查能力相关

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1639576, encodeId=19f316395e6a1, content=<a href='/topic/show?id=afda591646' target=_blank style='color:#2F92EE;'>#DIA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5916, encryptionId=afda591646, topicName=DIA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=987022654425, createdName=ms9608593228839890, createdTime=Sat Aug 15 12:48:58 CST 2020, time=2020-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1728628, encodeId=69121e2862849, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Sun Mar 14 00:48:58 CST 2021, time=2021-03-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922122, encodeId=2c4d92212223, content=CT在儿童中使用率下降, beContent=null, objectType=article, channel=null, level=null, likeNumber=140, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210110/e6124a4b19bc40ce8afaae096d21126b/dd778ac260c9416eb87e7d08139507f5.jpg, createdBy=4d2f5079605, createdName=科研科研科研, createdTime=Tue Feb 02 09:26:19 CST 2021, time=2021-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=911337, encodeId=3a3591133e3f, content=CT使用率, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=a37a1710612, createdName=oo902, createdTime=Sun Dec 27 19:37:19 CST 2020, time=2020-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=811251, encodeId=3996811251b0, content=不同情况选用不同的检查手段 急诊CT使用率应该是和疾病以及其他辅助检查能力相关, beContent=null, objectType=article, channel=null, level=null, likeNumber=138, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200809/b24f1ce03127421aaee1ade77b85a826/d600ec61f5e943a3b4229aa5660a3ad3.jpg, createdBy=85e15409722, createdName=Slie, createdTime=Thu Aug 20 07:09:45 CST 2020, time=2020-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615919, encodeId=364f161591999, content=<a href='/topic/show?id=158826812c4' target=_blank style='color:#2F92EE;'>#使用率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26812, encryptionId=158826812c4, topicName=使用率)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8dee19693687, createdName=ms3830150583600765, createdTime=Thu Aug 13 09:48:58 CST 2020, time=2020-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036215, encodeId=a4fc103621514, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Tue Aug 11 21:48:58 CST 2020, time=2020-08-11, status=1, ipAttribution=)]
  7. [GetPortalCommentsPageByObjectIdResponse(id=1639576, encodeId=19f316395e6a1, content=<a href='/topic/show?id=afda591646' target=_blank style='color:#2F92EE;'>#DIA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=87, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5916, encryptionId=afda591646, topicName=DIA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=987022654425, createdName=ms9608593228839890, createdTime=Sat Aug 15 12:48:58 CST 2020, time=2020-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1728628, encodeId=69121e2862849, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Sun Mar 14 00:48:58 CST 2021, time=2021-03-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=922122, encodeId=2c4d92212223, content=CT在儿童中使用率下降, beContent=null, objectType=article, channel=null, level=null, likeNumber=140, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210110/e6124a4b19bc40ce8afaae096d21126b/dd778ac260c9416eb87e7d08139507f5.jpg, createdBy=4d2f5079605, createdName=科研科研科研, createdTime=Tue Feb 02 09:26:19 CST 2021, time=2021-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=911337, encodeId=3a3591133e3f, content=CT使用率, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=a37a1710612, createdName=oo902, createdTime=Sun Dec 27 19:37:19 CST 2020, time=2020-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=811251, encodeId=3996811251b0, content=不同情况选用不同的检查手段 急诊CT使用率应该是和疾病以及其他辅助检查能力相关, beContent=null, objectType=article, channel=null, level=null, likeNumber=138, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200809/b24f1ce03127421aaee1ade77b85a826/d600ec61f5e943a3b4229aa5660a3ad3.jpg, createdBy=85e15409722, createdName=Slie, createdTime=Thu Aug 20 07:09:45 CST 2020, time=2020-08-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1615919, encodeId=364f161591999, content=<a href='/topic/show?id=158826812c4' target=_blank style='color:#2F92EE;'>#使用率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=101, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26812, encryptionId=158826812c4, topicName=使用率)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8dee19693687, createdName=ms3830150583600765, createdTime=Thu Aug 13 09:48:58 CST 2020, time=2020-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036215, encodeId=a4fc103621514, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Tue Aug 11 21:48:58 CST 2020, time=2020-08-11, status=1, ipAttribution=)]
    2020-08-11 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

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