Eisenberg Jonathan D, Reisner Andrew T, Binder William D, Zaheer Atif, Gunn Martin L, Linnau Ken F, Miller Chad M, Tramontano Angela C, Herring Maurice S, Dowling Emily C, Halpern Elkan F, Donelan Karen, Gazelle G Scott, Pandharipande Pari V
1 University of Massachusetts Medical School, Worcester, MA.
2 Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac St, 10th Fl, Boston, MA 02114.
AJR Am J Roentgenol. 2017 Mar;208(3):570-576. doi: 10.2214/AJR.16.16669. Epub 2017 Jan 11.
The objective of our study was to determine whether specific patient and physician factors-known before CT-are associated with a diagnosis of nonspecific abdominal pain (NSAP) after CT in the emergency department (ED).
We analyzed data originally collected in a prospective multicenter study. In the parent study, we identified ED patients referred to CT for evaluation of abdominal pain. We surveyed their physicians before and after CT to identify changes in leading diagnoses, diagnostic confidence, and admission decisions. In the current study, we conducted a multiple regression analysis to identify whether the following were associated with a post-CT diagnosis of NSAP: patient age; patient sex; physicians' years of experience; physicians' pre-CT diagnostic confidence; and physicians' pre-CT admission decision if CT had not been available. We analyzed patients with and those without a pre-CT diagnosis of NSAP separately. For the sensitivity analysis, we excluded patients with different physicians before and after CT.
In total, 544 patients were included: 10% (52/544) with a pre-CT diagnosis of NSAP and 90% (492/544) with a pre-CT diagnosis other than NSAP. The leading diagnoses changed after CT in a large proportion of patients with a pre-CT diagnosis of NSAP (38%, 20/52). In regression analysis, we found that physicians' pre-CT diagnostic confidence was inversely associated with a post-CT diagnosis of NSAP in patients with a pre-CT diagnosis other than NSAP (p = 0.0001). No other associations were significant in both primary and sensitivity analyses.
With the exception of physicians' pre-CT diagnostic confidence, the factors evaluated were not associated with a post-CT diagnosis of NSAP.
我们研究的目的是确定在进行CT检查之前已知的特定患者和医生因素是否与急诊科（ED）CT检查后非特异性腹痛（NSAP）的诊断相关。
我们分析了最初在前瞻性多中心研究中收集的数据。在原研究中，我们确定了因腹痛接受CT检查的急诊科患者。我们在CT检查前后对他们的医生进行了调查，以确定主要诊断、诊断信心和入院决定的变化。在本研究中，我们进行了多元回归分析，以确定以下因素是否与CT检查后NSAP的诊断相关：患者年龄；患者性别；医生的工作年限；医生在CT检查前的诊断信心；以及如果没有CT检查，医生在CT检查前的入院决定。我们分别分析了CT检查前诊断为NSAP和未诊断为NSAP的患者。为进行敏感性分析，我们排除了CT检查前后由不同医生诊治的患者。
总共纳入了544例患者：CT检查前诊断为NSAP的患者占10%（52/544），CT检查前诊断为非NSAP的患者占90%（492/544）。在CT检查前诊断为NSAP的大部分患者（38%，20/52）中，CT检查后主要诊断发生了变化。在回归分析中，我们发现，在CT检查前诊断为非NSAP的患者中，医生在CT检查前的诊断信心与CT检查后NSAP的诊断呈负相关（p = 0.0001）。在主要分析和敏感性分析中，没有其他关联具有显著性。
除医生在CT检查前的诊断信心外，所评估的因素与CT检查后NSAP的诊断无关。
