Discipline of Medical Imaging, Department of Imaging and Applied Physics, Curtin University, Perth, WA, Australia.
Int J Clin Pract. 2013 Jul;67(7):682-90. doi: 10.1111/ijcp.12186.
In assessing patients with headaches, general practitioners (GPs) play an important role in determining which patients require computed tomography (CT) scans. The purpose of this study was to identify factors that influence GPs' decisions to refer CT scans for patients with headaches.
A self-administered survey was presented to GPs in Western Australia. One hundred and twenty-eight vignettes describing patients who may have required CT referral for headache were constructed encompassing six clinical variables. Nine vignettes, selected at random, were presented to each respondent. Respondents were asked if they would refer the patient for diagnostic imaging tests, if so, which imaging modalities would they request, how urgently and the perceived benefits of the requested imaging modality. Multinomial logistic regression was used for the multivariate analysis.
We received 105 completed questionnaires (21%). GPs were more likely to refer patients with headaches for diagnostic imaging and CT scans in the following clinical scenarios: patients with a history of colorectal cancer and epilepsy; and patients feeling unwell for the past 6 weeks and headache being exacerbated with valsalva manoeuvrers. Private health insurance and other respondent demographics such as GPs experience and site of care increased imaging referral.
GP's referral decisions of diagnostic imaging and CT examinations for patients with headaches are dependent on clinical scenarios and the likelihood of a significant pathology. Further research is required to identify the significant clinical findings with regard to the CT referrals and ensure that CT scans are not requested in patients who are unlikely to benefit.
在评估头痛患者时，全科医生（GP）在确定哪些患者需要进行计算机断层扫描（CT）检查方面发挥着重要作用。本研究旨在确定影响 GP 决定为头痛患者转介 CT 扫描的因素。
对西澳大利亚的全科医生进行了一项自我管理的调查。共构建了 128 个描述可能需要 CT 转介头痛的患者的案例，涵盖了 6 个临床变量。向每个受访者随机呈现了 9 个案例。受访者被问及他们是否会将患者转介进行诊断性影像学检查，如果是，他们会要求哪些影像学检查，以及他们认为哪些影像学检查的益处更大。使用多项逻辑回归进行多变量分析。
我们收到了 105 份完整的问卷（21%）。在以下临床情况下，GP 更有可能为头痛患者转介进行诊断性影像学和 CT 扫描：有结直肠癌和癫痫病史的患者；过去 6 周身体不适且valsalva 动作加重头痛的患者。私人医疗保险和其他受访者特征，如 GP 的经验和护理地点，增加了影像学的转介。
GP 对头痛患者进行诊断性影像学和 CT 检查的转介决策取决于临床情况和发生重大病理的可能性。需要进一步研究以确定与 CT 转介相关的重要临床发现，并确保在不太可能受益的患者中不要求进行 CT 扫描。
