Department of Medicine, Lenox Hill Hospital, 100 East 77th St., New York, NY 10075, USA.
J Vasc Interv Radiol. 2012 Aug;23(8):989-95. doi: 10.1016/j.jvir.2012.04.017. Epub 2012 Jun 13.
Inferior vena cava (IVC) filter placement has increased significantly over the past few decades, but indications for filter placement vary widely depending on which professional society recommendations are followed, and it is uncertain how compliant physicians are in adhering to guidelines. This study assessed documented indications for IVC filter placement and evaluated compliance with standards set by the American College of Chest Physicians (ACCP) and the Society of Interventional Radiology (SIR).
A single-center, retrospective medical record review in a metropolitan, 652-bed, acute care, teaching hospital. Inpatient filter placement over a 26-month period was reviewed. The study measured compliance with established guidelines, relationship of medical specialty to filter placement, and evaluation of self-referral patterns among physicians.
Compliance with established ACCP guidelines was poor regardless of whether the IVC filter insertion was performed by interventional radiology (IR; 43.5%), vascular surgery (VS; 39.9%), or interventional cardiology (IC; 33.3%) staff. Compliance with the less restrictive SIR guidelines was better (77.5%, 77.1%, and 80% for IR, VS, and IC, respectively). There was a greater degree of guideline compliance when filter placement was recommended by internal medicine (IM)-trained physicians than by non-IM-trained physicians: 46.3% of IR-placed filters requested by IM physicians met ACCP criteria whereas only 24.0% of filters recommended by non-IM specialties were compliant with criteria (P = .03). In the VS group, these compliance rates were 45.8% and 31.5%, respectively (P = .03). Among IR-placed filters, 84.0% of IM-recommended filter placements were compliant with SIR guidelines, versus only 48.0% of non-IM-recommended placements (P ≤ .001). In the VS group, these compliance rates were 87.8% and 69.6%, respectively (P ≤ .001).
There is poor physician compliance with guidelines for IVC filter placement. Most filter indications meeting SIR guidelines are for patients classified as "falls risks," failures of anticoagulation, patients with limited cardiopulmonary reserve and patients non compliant with anticoagulation medications. This single-center study suggests a need for harmonization of current guidelines espoused by professional societies.
下腔静脉（IVC）滤器的放置在过去几十年中显著增加，但滤器放置的适应证因遵循哪个专业学会的建议而存在很大差异，并且尚不确定医生在遵循指南方面的依从性如何。本研究评估了 IVC 滤器放置的记录适应证，并评估了美国胸科医师学会（ACCP）和介入放射学会（SIR）制定的标准的符合程度。
在一家位于大都市的 652 张病床的急性护理教学医院中，进行了单中心回顾性病历审查。对 26 个月期间的住院患者滤器放置进行了回顾。该研究衡量了对既定指南的遵守情况、医疗专业与滤器放置的关系，以及评估医生的自我转诊模式。
无论 IVC 滤器插入是由介入放射科（IR）、血管外科（VS）还是介入心脏病学（IC）人员进行，对 ACCP 指南的遵守情况都很差（IR：43.5%，VS：39.9%，IC：33.3%）。对限制较少的 SIR 指南的遵守情况更好（IR、VS 和 IC 分别为 77.5%、77.1%和 80%）。当内科医生（IM）推荐放置滤器时，遵循指南的程度更高：46.3%的由 IM 医生推荐的 IR 放置的滤器符合 ACCP 标准，而由非 IM 专科推荐的滤器仅有 24.0%符合标准（P=0.03）。在 VS 组中，这些符合率分别为 45.8%和 31.5%（P=0.03）。在 IR 放置的滤器中，84.0%的由 IM 推荐的滤器放置符合 SIR 指南，而只有 48.0%的非 IM 推荐的放置符合（P≤0.001）。在 VS 组中，这些符合率分别为 87.8%和 69.6%（P≤0.001）。
医生对 IVC 滤器放置指南的依从性很差。符合 SIR 指南的大多数滤器适应证都是针对“跌倒风险”、抗凝失败、心肺储备有限和不遵医嘱服用抗凝药物的患者。这项单中心研究表明，需要协调专业学会目前所支持的指南。
