过渡到计算机射线摄影：急诊医生能否准确预测胶片打印的需求，以促进最佳患者护理？
Transition to computed radiography: can emergency medicine doctors accurately predict the need of film printing to facilitate optimal patient care?
机构信息
Accident and Emergency Department, Kwong Wah Hospital, Hong Kong, China.
出版信息
World J Emerg Med. 2011;2(1):33-7.
BACKGROUND
This study aimed to evaluate emergency medicine doctors' accuracy in predicting the need of film printing in a simulated setting of computed radiography and assess whether this can facilitate optimal patient care.
METHODS
Cross sectional study was conducted from 20 March 2009 to 3 April 2009 in 1334 patients. After clinical assessment of those patients who needed X-ray examination, doctors in the emergency department would indicate whether film printing was necessary for subsequent patient care in a simulated computed radiography setting. The final discharge plan was then retrieved from each patient record. Accuracy of doctors' prediction was calculated by comparing the initial request for radiographic film printing and the final need of film. Doctors with different level of emergency medicine experience would also be analyzed and compared.
RESULTS
The sensitivity of predicting film printing was 84.5% and the specificity of predicting no film printing was 91.2%. Positive predictive value was 88.4% while negative predictive value was 88.2%. The overall accuracy was 88.2%. The accuracy of doctors stratified into groups of fellows, higher trainees and basic trainees were 85.4%, 90.5% and 88.5% respectively (P=0.073).
CONCLUSIONS
Our study showed that doctors can reliably predict whether film printing is needed after clinical assessment of patients, before actual image viewing. Advanced indication for film printing at the time of imaging request for selected patients can save time for all parties with minimal wastage.
背景
本研究旨在评估急诊医生在模拟计算机射线摄影环境下预测胶片打印需求的准确性，并评估这是否有助于为患者提供最佳护理。
方法
本横断面研究于 2009 年 3 月 20 日至 4 月 3 日在 1334 名患者中进行。对需要 X 射线检查的患者进行临床评估后，急诊医生会在模拟计算机射线摄影环境下指示后续患者护理是否需要胶片打印。然后从每位患者的病历中检索最终的出院计划。通过比较初始请求放射胶片打印和最终需要胶片的情况，计算医生预测的准确性。还对具有不同急诊医学经验水平的医生进行了分析和比较。
结果
预测胶片打印的敏感性为 84.5%，预测无需胶片打印的特异性为 91.2%。阳性预测值为 88.4%，阴性预测值为 88.2%。总体准确性为 88.2%。按研究员、高级培训生和基础培训生分组的医生的准确性分别为 85.4%、90.5%和 88.5%（P=0.073）。
结论
我们的研究表明，医生可以在对患者进行临床评估后、在实际查看图像之前可靠地预测是否需要胶片打印。在为选定患者进行影像请求时提前对胶片进行高级指示，可以在最小浪费的情况下为各方节省时间。
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