Department of Radiology, Mayo Clinic, Rochester, Minnesota 55904, USA.
J Am Coll Radiol. 2010;7(2):125-31. doi: 10.1016/j.jacr.2009.08.013.
The aim of this study was to evaluate published appropriateness criteria for CT angiography (CTA) at the authors' academic medical center.
Two observers independently reviewed the medical records of 251 patients who had undergone dual-source coronary CTA from June 1 to December 31, 2007. Patients were assigned to indications from 1 of 7 tables from the American College of Cardiology Foundation and ACR Appropriateness Criteria. Agreement between the two observers was assessed using kappa statistics. Disagreements were resolved by consensus panel. The final numbers of appropriate, uncertain, inappropriate, and not classifiable indications were recorded.
Indications for testing were classified as appropriate in 69 patients (27%), inappropriate in 42 patients (17%), and uncertain in 25 patients (10%). One hundred fifteen indications for coronary CTA (46%) were not classifiable. Analysis of interobserver variability for overall appropriateness yielded a kappa value of 0.31, which was considered to indicate fair agreement.
The results of this study suggest that a significant proportion (46%) of the coronary CTA studies performed at the authors' institution are for indications that are not covered by the published appropriateness criteria. Modifications to these criteria could help decrease the number of studies that are not classifiable. Physician education could decrease the number of inappropriate studies.
本研究旨在评估作者所在学术医疗中心发表的 CT 血管造影（CTA）适宜性标准。
两名观察者独立审查了 2007 年 6 月 1 日至 12 月 31 日期间进行双源冠状动脉 CTA 的 251 名患者的病历。患者被分配到美国心脏病学会基金会和 ACR 适宜性标准的 7 个表中的 1 个表中的适应证。使用 Kappa 统计评估两名观察者之间的一致性。通过共识小组解决分歧。记录最终的适宜、不确定、不适宜和不可分类的适应证数量。
检测的适应证被归类为适宜 69 例（27%）、不适宜 42 例（17%）和不确定 25 例（10%）。115 例冠状动脉 CTA 适应证（46%）不可分类。对总体适宜性的观察者间变异性分析得出 Kappa 值为 0.31，这被认为是公平一致的。
本研究的结果表明，作者所在机构进行的冠状动脉 CTA 研究中，相当一部分（46%）的适应证未涵盖在已发表的适宜性标准中。对这些标准进行修改可以帮助减少不可分类的研究数量。医生教育可以减少不适当的研究数量。
