Carton Matthieu, Auvert Bertran, Guerini Henri, Boulard Jean-Christophe, Heautot Jean-Francois, Landre Marie-France, Beauchet Alain, Sznajderi Marc, Brun-Ney Dominique, Chagnon Sophie
Inserm U88, Saint Maurice, France.
Clin Radiol. 2002 Feb;57(2):123-8. doi: 10.1053/crad.2001.0827.
To assess medical emergency radiology referral practice compared with a set of French guidelines and to measure the efficiency of computer-based guidelines on unnecessary medical imaging.
All radiological requests were computerized in the medical emergency departments of two French teaching hospitals. During control periods, radiological requests were recorded but no action was taken. During intervention periods, reminder displays on screen indicated the appropriate recommendations. Three control and three intervention periods of 1 month each were conducted. The percentage of requests that did not conform to the guidelines and variation related to periods of control and intervention were measured.
The proportion of requests that did not conform to the guidelines was 33.2% when the guidelines were inactive and decreased to 26.9% when the recommendations were active (P < 0.0001). The three imaging examinations (chest radiographs, abdominal plain radiographs and CT of the brain) accounted for more than 80% of all requests; more than 50% of abdominal plain radiographs requests did not conform with recommendations while this percentage was respectively 24.9% and 15.8% for chest radiographs and computed tomography (CT) of the brain. Seven situations accounted for 70% of non-conforming radiological referrals; in these situations, junior practitioners' knowledge was inadequate.
While the computer provided advice that was tailored to the needs of individual patients, concurrent with care, the effect of our intervention was weak. However, our study identified the few situations that were responsible for the majority of unnecessary radiological requests; we expect that this result could help clinicians and radiologists to develop more specific actions for these situations.
将医疗急救放射学转诊实践与一套法国指南进行比较，并衡量基于计算机的指南对不必要医学成像的有效性。
法国两家教学医院的急诊科所有放射学申请均实现了计算机化。在对照期，记录放射学申请但不采取任何行动。在干预期，屏幕上的提醒显示给出适当的建议。分别进行了三个为期1个月的对照期和三个为期1个月的干预期。测量不符合指南的申请百分比以及与对照期和干预期相关的差异。
当指南未启用时，不符合指南的申请比例为33.2%，当建议启用时，该比例降至26.9%（P < 0.0001）。三项成像检查（胸部X光片、腹部平片和脑部CT）占所有申请的80%以上；超过50%的腹部平片申请不符合建议，而胸部X光片和脑部计算机断层扫描（CT）的这一比例分别为24.9%和15.8%。七种情况占不符合规定的放射学转诊的70%；在这些情况下，初级从业者的知识不足。
虽然计算机在提供护理的同时提供了针对个体患者需求的建议，但我们的干预效果较弱。然而，我们的研究确定了导致大多数不必要放射学申请的少数情况；我们预计这一结果有助于临床医生和放射科医生针对这些情况制定更具体的措施。
