急诊科头晕就诊中 CT 扫描的价值：一项全国代表性样本分析。
Value of computed tomography scans in ED dizziness visits: analysis from a nationally representative sample.
机构信息
Department of Neurology, University of Michigan Health System, Ann Arbor, MI 48109, USA.
出版信息
Am J Emerg Med. 2010 Nov;28(9):1030-6. doi: 10.1016/j.ajem.2009.06.007. Epub 2010 Jan 28.
OBJECTIVE
The study aimed to assess measures of the clinical value of computed tomography (CT) scans in dizziness presentations at the aggregate level.
METHODS
Using emergency department (ED) dizziness presentations captured in the National Hospital Ambulatory Medical Care Survey, the proportion of dizziness visits with a CT scan that received a central nervous system (CNS) diagnosis was measured yearly (1995-2004) and assessed for a trend over time. The independent association of having a CT scan with ED length of stay was examined using multivariable linear regression models.
RESULTS
The proportion of dizziness visits with a CT scan that received a CNS diagnosis dropped 62% from 1995 to 2004 (P < .05). By 2004, 94.1% (95% confidence interval, 89.4%-96.7%) of dizziness visits with a CT did not receive a CNS diagnosis. Having a CT scan was associated with a substantial increase in the length of stay with the effect modified by the number of other tests performed (range of increase, 40-77 minutes).
CONCLUSION
The clinical value of CT scans in dizziness presentations at the aggregate level may be very low and appears to have dropped over time. Computed tomography scans in the general dizziness population could also be an important contributor to ED length of stay. Use of CT scans in dizziness presentations should be a target for efforts to optimize the effectiveness and efficiency of care.
目的
本研究旨在评估计算机断层扫描（CT）在汇总层面上对头晕表现的临床价值的衡量标准。
方法
利用国家医院门诊医疗调查中急诊科（ED）头晕就诊记录，每年（1995-2004 年）测量并评估 CT 扫描在中枢神经系统（CNS）诊断中所占比例的时间趋势。使用多变量线性回归模型来检查 CT 扫描与 ED 住院时间之间的独立关联。
结果
从 1995 年到 2004 年，接受 CT 扫描的头晕就诊者中被诊断为 CNS 疾病的比例下降了 62%（P<.05）。到 2004 年，94.1%（95%置信区间，89.4%-96.7%）的 CT 扫描头晕就诊者未被诊断为 CNS 疾病。进行 CT 扫描与住院时间的显著增加相关，其效果受进行的其他测试数量的影响（增加幅度范围为 40-77 分钟）。
结论
在汇总层面上，CT 扫描在头晕表现中的临床价值可能非常低，而且似乎随着时间的推移而下降。在一般头晕人群中进行 CT 扫描也可能是 ED 住院时间延长的一个重要原因。应将 CT 扫描在头晕表现中的使用作为优化护理有效性和效率的努力目标。
Zotero 插件