在急诊室使用CT并不会过度评估胃肠疼痛


  2003 年5月9日-根据一项在5月6日美国X射线协会圣地牙哥年会上所发表的报告,在急诊室使用计算机断层扫描(CT) 并不会过度评估胃肠疼痛。虽然一半以上的扫瞄证实了怀疑的诊断,但是四分之一的扫描显示出患者症状未受怀疑的病因。
  
  这项顾展研究一共回顾了6个月中,共计633项在波士顿马萨诸塞综合医院的急诊室所进行的CT检测。在CT检测之前,三分之二的医师做出了怀疑的诊断,50% 到60%是由CT证实。
  
  主要作者Susanna I. Lee博士在新闻稿中表示,这项结果是正确的,如果结果更高,则表示即使医师已经有足够的信息做出正确的诊断,仍进行许多CT检测,如果结果更低,则表示CT检测无法提供医师参考的信息。
  
  在三分之一的病例中,医师在进行CT检测之前,都未做出怀疑的诊断。但是,在这些病例中有40%的CT结果是阳性的,并且在25%的病例中,CT显现出未以临床研究发现为基础的诊断。
  
  急诊室中的胃肠疼痛CT检测为82%,甚至高于肾脏绞痛,CT所做出的非怀疑诊断通常是进行妇产科的程序。
  
  根据Lee博士所言,胃肠CT经常用来诊断盲肠炎、肾绞痛、憩室炎和其它疾病。Lee说,我们的研究显示,它已经被广为运用,因为这是它固有的功能。

Emergency Room CT Not Overused

By Laurie Barclay, MD
Medscape Medical News

May 9, 2003 — Computed tomography (CT) is not overused in the emergency room for evaluating abdominal pain, according to a presentation on May 6 at the American Roentgen Ray Society annual meeting in San Diego, California. Although more than half the scans confirmed the suspected diagnosis, a quarter of the scans revealed an unsuspected cause for the patient's symptoms.

This retrospective study reviewed 633 CT studies done in the emergency room of the Massachusetts General Hospital in Boston during a six-month period. Before the CT examination, two thirds of the referring physicians had a suspected diagnosis, which was confirmed by the CT 50% to 60% of the time.

"This yield is just about right," lead author Susanna I. Lee, MD, says in a news release. "If the yield was higher, it would have indicated that a lot of CT examinations were being done even though the referring physician already had enough information to make a correct diagnosis. If the yield was much lower, it would have indicated that CT examinations were being ordered that weren't providing information needed by the referring physician."

In one third of cases, the referring physician had no suspected diagnosis before CT examination. However, CT was positive in 40% of these cases, and in 25%, the CT revealed a diagnosis that had not been considered based on clinical findings.

Overall yield of CT for abdominal pain in the emergency room was 82%, and it was even greater for renal colic. Unsuspected diagnoses made by CT were most often of a gynecological process.

According to Dr. Lee, abdominal CT is being used more often to diagnose appendicitis, renal colic, diverticulitis, and other diseases. "Our study shows it is being utilized more because it is doing what it is supposed to be doing," she says.

ARRS 103rd Annual Meeting: Abstract 177. Presented May 6, 2003.

Reviewed by Gary D. Vogin, MD

    
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