Prabhakar Anand M, Le Thang Q, Abujudeh Hani H, Raja Ali S
Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Division of Emergency Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Am J Emerg Med. 2015 Nov;33(11):1639-41. doi: 10.1016/j.ajem.2015.07.078. Epub 2015 Jul 29.
The aim of this study was to assess the outcomes, incidental findings, recommendations, and adherence to recommendations on computed tomography angiography (CTA) studies obtained in the emergency department (ED) to evaluate for aortic dissection.
The institutional database of ED patients was retrospectively reviewed to identify CTA examinations for dissection during 2014. The radiology report and electronic medical records were reviewed to assess outcomes, radiology report incidental findings, and recommendations, as well as adherence to these recommendations.
There were 370 dissection CTAs performed during the 12-month study period. The average age of the patients was 63 years (range, 15-97 years). Eighty-seven patients (23.5%) had clinically significant aortic pathology including 46 patients (12.4%) with dissection and 19 (5.1%) which were new. Three hundred twenty-nine (88.9%) of patients had at least 1 incidental finding. One hundred six (28.6%) of patients had recommendations on the radiology report, and 44.3% of these were for pulmonary nodules. Thirty recommendations (28.3%) were acted upon, most commonly related to pulmonary nodule.
Computed tomography angiography is useful in detecting aortic pathology. However, emergency physicians should be aware of the potential for clinically significant incidental findings and recommendations. Adherence to recommendations was limited, and future research could investigate mechanisms to improve compliance.
本研究旨在评估在急诊科（ED）进行的计算机断层扫描血管造影（CTA）检查的结果、偶然发现、建议以及对这些建议的遵循情况，以评估主动脉夹层。
回顾性审查ED患者的机构数据库，以确定2014年期间用于夹层评估的CTA检查。审查放射学报告和电子病历，以评估结果、放射学报告中的偶然发现和建议，以及对这些建议的遵循情况。
在为期12个月的研究期间共进行了370次夹层CTA检查。患者的平均年龄为63岁（范围为15 - 97岁）。87例患者（23.5%）有临床上显著的主动脉病变，其中46例（12.4%）为夹层，19例（5.1%）为新发病变。329例（88.9%）患者至少有1项偶然发现。106例（28.6%）患者的放射学报告中有建议，其中44.3%是针对肺结节的。30项建议（28.3%）得到了执行，最常见的与肺结节有关。
计算机断层扫描血管造影在检测主动脉病变方面很有用。然而，急诊医生应意识到临床上显著的偶然发现和建议的可能性。对建议的遵循情况有限，未来的研究可以探讨提高依从性的机制。
