适宜性标准在门诊经胸超声心动图检查中的应用。
Application of appropriateness criteria in outpatient transthoracic echocardiography.
作者信息
Kirkpatrick James N, Ky Bonnie, Rahmouni Hind W, Chirinos Julio A, Farmer Steven A, Fields Anjali V, Ogbara Jeffrey, Eberman Karen M, Ferrari Victor A, Silvestry Frank E, Keane Martin G, Opotowsky Alexander R, Sutton Martin St John, Wiegers Susan E
机构信息
Department of Medicine, Cardiovascular Division, Echocardiography Laboratory, University of Pennsylvania, Philadelphia, PA 19104, USA.
出版信息
J Am Soc Echocardiogr. 2009 Jan;22(1):53-9. doi: 10.1016/j.echo.2008.10.020.
BACKGROUND
Appropriateness criteria were applied to outpatient transthoracic echocardiographic (TTE) studies.
METHODS
Indications were rated as appropriate, inappropriate, or unclassifiable, considering provider-stated indications, previous TTE studies, symptom changes, and patient-stated indications. Clinically important new or unexpected findings were recorded.
RESULTS
Of 368 TTE studies, 206 (56%) were appropriate, 31 (8%) were inappropriate, and 131 (35%) were unclassifiable. Appropriateness was not correlated with patient or provider demographics. In 288 cases with prior TTE studies, there were 92 (32%) important new findings and 63 (22%) unexpected findings, of which 20% were from inappropriately ordered and 31% from unclassifiable TTE studies. Appropriateness was not associated with new (odds ratio, 1.23; 95% confidence interval, 0.48-3.18) or unexpected (odds ratio, 1.15; 95% confidence interval, 0.38-3.52) findings. Provider type and level of training were not correlated with new or unexpected findings.
CONCLUSIONS
Many indications for TTE studies were unclassifiable. A high percentage of inappropriately ordered TTE studies yielded important information. Care must be taken in judging the value of TTE studies solely on the basis of appropriateness criteria.
背景
将适用性标准应用于门诊经胸超声心动图（TTE）检查。
方法
根据医生陈述的指征、既往TTE检查、症状变化以及患者陈述的指征，将指征评定为合适、不合适或无法分类。记录具有临床重要意义的新发现或意外发现。
结果
在368例TTE检查中，206例（56%）是合适的，31例（8%）是不合适的，131例（35%）是无法分类的。适用性与患者或医生的人口统计学特征无关。在288例有既往TTE检查的病例中，有92例（32%）重要新发现和63例（22%）意外发现，其中20%来自检查医嘱开具不当的TTE检查，31%来自无法分类的TTE检查。适用性与新发现（优势比，1.23；95%置信区间，0.48 - 3.18）或意外发现（优势比，1.15；95%置信区间，0.38 - 3.52）无关。医生类型和培训水平与新发现或意外发现无关。
结论
许多TTE检查的指征无法分类。很大比例的检查医嘱开具不当的TTE检查产生了重要信息。仅根据适用性标准判断TTE检查的价值时必须谨慎。
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