Belloni Elena, Tentoni Stefania, Cella Alessandra, Cassinelli Davide, Bertè Raffaella, Scagnelli Paola
Department of Radiology, Civil Hospital, Viale 2 Giugno, 29015, Castel San Giovanni, Piacenza Province, Italy.
Institute of Applied Mathematics and Information Technologies "Enrico Magenes", National Research Council, Via Ferrata 1, 27100, Pavia, Italy.
Radiol Med. 2017 Oct;122(10):793-797. doi: 10.1007/s11547-017-0776-0. Epub 2017 May 25.
To evaluate frequency, type, and cost of diagnostic and interventional radiological exams performed on end-stage oncologic patients in the 90 days before Hospice admission.
Data of patients admitted to Hospice from January 2012 through June 2013 (18 months) were cross-checked with data from the digital archive of the Radiology Department. Frequency and type of exams performed before admission were analyzed across three 1-month periods, namely M, M, M, corresponding to 90-61, 60-31 and 30-1 days before admission. The Regional Range of Fees was used to determine the costs.
A total of 389 patients were admitted to Hospice. Before admission, 335 patients (86%) underwent 1543 radiological exams: 919 X-rays, 555 CTs, 39 MRs, and 30 interventional procedures. The cost of these services was € 106,988 (€ 19,918 for X-rays, € 73,956 for CTs, € 9502 for MRs, and € 3612 for interventional procedures). Across the pre-Hospice periods, the proportions of examined patients increased as admission approached: 36% in M, 43% in M (P = .038), 65% in M (P < .001). The mean number of exams increased significantly, too (P < .001).
A substantial number of end-stage oncologic patients underwent radiological exams in the 90 days before Hospice admission, and these numbers grew as Hospice access approached. In the end-of-life span, diagnostic excesses should be avoided.
评估临终关怀入院前90天对晚期肿瘤患者进行的诊断性和介入性放射学检查的频率、类型及费用。
将2012年1月至2013年6月（18个月）入住临终关怀机构的患者数据与放射科数字存档数据进行交叉核对。在入院前的三个1个月时间段，即M、M、M，分别对应入院前90 - 61天、60 - 31天和30 - 1天，分析入院前进行检查的频率和类型。使用地区收费范围来确定费用。
共有389名患者入住临终关怀机构。入院前，335名患者（86%）接受了1543次放射学检查：919次X线检查、555次CT检查、39次磁共振成像检查以及30次介入操作。这些服务的费用为106,988欧元（X线检查19,918欧元、CT检查73,956欧元、磁共振成像检查9502欧元、介入操作3612欧元）。在临终关怀前的各个时间段，随着入院时间临近，接受检查的患者比例增加：M期为36%，M期为43%（P = 0.038），M期为65%（P < 0.001）。检查的平均次数也显著增加（P < 0.001）。
大量晚期肿瘤患者在临终关怀入院前90天接受了放射学检查，且随着接近临终关怀入院，检查次数增多。在生命末期，应避免过度诊断。
