Bunt Christopher W, Burke Harry B, Towbin Alexander J, Hoang Albert, Stephens Mark B, Fontelo Paul, Liu Fang, Gimbel Ronald W
From the Departments of Family Medicine (CWB, MBS) and Medicine (HBB, AH), Uniformed Services University, Bethesda, MD; the Department of Pediatric Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH (AJT); the Lister Hill National Center for Biomedical Communications, National Library of Medicine, Bethesda, MD (PF, FL); and the Department of Public Health Sciences, Clemson University, Clemson, SC (RWG).
J Am Board Fam Med. 2015 May-Jun;28(3):343-50. doi: 10.3122/jabfm.2015.03.140251.
The steady increase in the use of computed tomography (CT) has particular concerns for children. Family physicians must often select pediatric imaging without any decision support. We hypothesized that point-of-care decision support would lead to the selection of imaging that lowered radiation exposure and improved guideline congruence.
Our double-blind, randomized simulation included family physicians in the Military Health System. Participants initially reviewed a pediatric hematuria scenario and selected imaging without decision support. Participants were subsequently randomized to either receive imaging-appropriateness guidelines and then estimated radiation exposure information or receive estimated radiation information then guidelines; imaging selections were required after each step. The primary outcome was the selected imaging modality with point-of-care decision support.
The first arm increased CT ordering after viewing the guidelines (P = .008) but then decreased it after reviewing radiation exposure information (P = .007). In the second arm radiation information decreased CT and plain film use (P = not significant), with a subsequent increase in ultrasound and CT after the guideline presentation (P = .05).
Decision support during a simulated pediatric scenario helped family physicians select imaging that lowered radiation exposure and was aligned with current guidelines, especially when presented with radiation information after guideline review. This information could help inform electronic medical record design.
计算机断层扫描（CT）使用量的稳步增加尤其令人担忧儿童的情况。家庭医生在选择儿科影像检查时往往没有任何决策支持。我们假设即时医疗决策支持将有助于选择降低辐射暴露且符合指南的影像检查。
我们的双盲随机模拟研究纳入了军事医疗系统中的家庭医生。参与者最初审查一个儿科血尿病例并在没有决策支持的情况下选择影像检查。随后参与者被随机分为两组，一组先接收影像检查适宜性指南，然后估计辐射暴露信息；另一组先接收估计辐射信息，然后接收指南；在每个步骤后都需要进行影像检查选择。主要结果是即时医疗决策支持下所选的影像检查方式。
第一组在查看指南后增加了CT检查的开具（P = 0.008），但在查看辐射暴露信息后又减少了（P = 0.007）。在第二组中，辐射信息减少了CT和平片的使用（P = 无显著差异），在呈现指南后超声和CT的使用随后增加（P = 0.05）。
在模拟儿科病例过程中的决策支持有助于家庭医生选择降低辐射暴露且符合当前指南的影像检查，特别是在指南审查后呈现辐射信息时。这些信息可为电子病历设计提供参考。
