1 Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire.
Ann Am Thorac Soc. 2014 Feb;11(2):211-4. doi: 10.1513/AnnalsATS.201307-242BC.
Standard radiology report forms do not guide ordering clinicians toward evidence-based practice.
To test an enhanced radiology report that estimates the probability that a pulmonary nodule is malignant and provides explicit, professional guideline recommendations.
Anonymous, institutional review board-approved, internet-based survey of all clinicians with privileges at the Dartmouth-Hitchcock Medical Center comparing a standard versus an enhanced chest computed tomography report for a 65-year-old former smoker with an incidentally detected 7-mm pulmonary nodule.
A total of 43% (n = 447) of 1045 eligible clinicians answered patient management questions after reading a standard and then an enhanced radiology report (which included the probability of malignancy and Fleischner Society guideline recommendations). With the enhanced report, more clinicians chose the correct management strategy (72% with enhanced versus 32% with standard report [40% difference; 95% confidence interval (CI) = 35-45%]), appropriately made fewer referrals to pulmonary for opinions or biopsy (21 vs. 41% [-40% difference; 95% CI = -25 to -16%]), ordered fewer positron emission tomography scans (3 versus 13%; -10% difference; 95% CI = -13 to -7%), and fewer computed tomography scans outside the recommended time interval (2 versus 7%; -5% difference; 95% CI = -7 to -2%). Most clinicians preferred or strongly preferred the enhanced report, and thought they had a better understanding of the nodule's significance and management.
An enhanced radiology report with probability estimates for malignancy and management recommendations was associated with improved clinicians' response to incidentally detected small pulmonary nodules in an internet-based survey of clinicians at one academic medical center, and was strongly preferred. The utility of this approach should be tested next in clinical practice.
标准放射学报告形式并不能引导临床医生采用循证实践。
测试一种增强型放射学报告，该报告可估计肺结节恶性的概率，并提供明确的专业指南建议。
对达特茅斯-希区柯克医疗中心所有有特权的临床医生进行匿名、机构审查委员会批准的基于互联网的调查，比较标准与增强型胸部计算机断层扫描报告，对象为一位偶然发现的 7 毫米直径的 65 岁曾吸烟者的肺结节。
共有 1045 名符合条件的临床医生中的 43%（n = 447）回答了患者管理问题，他们在阅读标准和增强型放射学报告后（包括恶性肿瘤的概率和 Fleischner 学会指南建议）。使用增强型报告，更多的临床医生选择了正确的管理策略（增强型报告为 72%，标准报告为 32%[40%差异；95%置信区间（CI）= 35-45%]），适当减少了向肺科医生征求意见或进行活检的转诊（21%对 41%[-40%差异；95% CI = -25 至 -16%]），减少了正电子发射断层扫描（PET）扫描（3 次对 13%[-10%差异；95% CI = -13 至 -7%]），以及在推荐时间间隔之外进行的计算机断层扫描（2 次对 7%[-5%差异；95% CI = -7 至 -2%]）。大多数临床医生更喜欢或强烈更喜欢增强型报告，并认为他们更好地了解了结节的意义和管理。
在一家学术医疗中心的临床医生的互联网调查中，一种具有恶性概率估计和管理建议的增强型放射学报告与改善对偶然发现的小肺结节的临床医生反应有关，并得到了强烈的青睐。接下来应在临床实践中测试这种方法的实用性。
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