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我们可以减少在轻度颅脑损伤中CT的使用量吗?
原作者: Wan-Tsu Wendy Chang, 文章来源: 《中华急诊医学杂志》编辑部 发布日期:2014-12-17

Title: Can we decrease CT utilization in mild TBI?
题目:我们可以减少在轻度颅脑损伤中CT的使用量吗?
Author 作者: Wan-Tsu Wendy Chang
翻译:江利冰 校对:肖锋

Does clinical decision support help reduce head CT utilization in mild traumatic brain injury related ED visits?
对于轻度颅脑损伤的急诊患者,使用临床决策支持系统是否有助于减少脑CT的使用?
•Mild traumatic brain injury (mTBI) account for approximately 1.2 million outpatient visits per year
•每年门诊患者中大概有120万的轻度颅脑损伤患者(mTBI)。
•Almost 1 million of these mTBI patients undergo head CT as part of their evaluation
•在这些(mTBI)患者中,大概有100万将脑CT作为他们评估的手段之一。
•Less than 6% have significant intracranial injuries that require neurosurgical intervention
•小于6%的患者可以发现需要神经外科介入的明显颅内损伤。
Are we utilizing clinical decision rules adequately to help us appropriately select patients for CT imaging?
我们是否充分利用了临床决策规范帮助我们选择哪些患者需要进行CT扫描?
Can clinical decision support (CDS) help us reduce head CT utilization in mTBI related ED visits?
临床决策支持是否会帮助我们减少mTBI患者接受脑CT检查?
•A recent study by Ip et al. reported on the use of a real-time computerized CDS in an EMR/CPOE system to provide feedback to an ordering provider on "low utility" CT's based on clinical decision rules (New Orleans Criteria, Canadian CT Head Rule, CT in Head Injury Patients Prediction Rule)
• Ip et al最近的一项研究报道了在电子病历/医生医嘱录入系统使用实时的计算机临床决策支持,该系统根据临床决策规范(新奥尔良标准、加拿大脑CT规范、脑损伤评估CT规范)将“减少使用”的信息反馈给开具CT检查的临床医生。
•Over a 2 year period, 1221 of 1988 (64%) of mTBI related ED visits were associated with a head CT being performed
•2年多期间,1988例急诊mTBI患者中,1221例(64%)接受了脑CT检查。
•A 13.4% decrease in CT utilization was seen in the CDS intervention group (58.1% pre- vs. 50.3% post-, p=0.005)
•在干预组(使用临床决策支持),头颅CT检测率减少了13.4%(干预前:58.1%;干预后50.3%,P=0.005)。
•A control cohort using the National Hospital Ambulatory Medical Care Survey (NHAMCS) as a representative of emergency medical care delivered in the U.S. showed no significant change in CT utilization in the same time period (73.3% pre- vs. 76.9% post-, p=0.272)
•一个使用全国医院门诊病人医疗管理调查作为美国急诊医疗服务标志的对比研究,显示在同时期CT的使用量是没有明显变化的(干预前73.3%;干预后76.9%,p=0.272)。
Take Home Point:
要点:
Clinical decision support may be a useful tool to help reduce CT utilization in mild TBI related ED visits.
对于轻度颅脑损伤的急诊患者,临床决策支持方案可能是减少脑CT使用量的一种有用工具。

References
参考文献
Ip IK, Raja AS, Gupta A, et al. Impact of clinical decision support on head CT use in patients with mild traumatic brain injury in the emergency department. Am J Emerg Med 2014; Nov 13 [epub ahead of print]

文章来源:《中华急诊医学杂志》编辑部