Alderazi Ahmed Ali, Lynch Mary
Department of Medicine, Royal College of Surgeons in Ireland, Medical University of Bahrain, Busiateen, Bahrain.
Mohammed bin Khalifa Cardiac Centre, Bahrain.
Heart Views. 2017 Jan-Mar;18(1):8-12. doi: 10.4103/1995-705X.206203.
In response to growing concerns regarding the overuse of coronary computed tomography angiography (CCTA) in the clinical setting, multiple societies, including the American College of Cardiology Foundation, have jointly published revised criteria regarding the appropriate use of this imaging modality. However, previous research indicates significant discrepancies in the rate of adherence to these guidelines.
To assess the appropriateness of CCTA referrals in a tertiary cardiac center in Bahrain.
This retrospective clinical audit examined the records of patients referred to CCTA between the April 1, 2015 and December 31, 2015 in Mohammed bin Khalifa Cardiac Center. Using information from medical records, each case was meticulously audited against guidelines to categorize it as appropriate, inappropriate, or uncertain.
Of the 234 records examined, 176 (75.2%) were appropriate, 47 (20.1%) were uncertain, and 11 (4.7%) were inappropriate. About 74.4% of all referrals were to investigate coronary artery disease (CAD). The most common indication that was deemed appropriate was the detection of CAD in the setting of suspected ischemic equivalent in patients with an intermediate pretest probability of CAD (65.9%). Most referrals deemed inappropriate were requested to detect CAD in asymptomatic patients at low or intermediate risk of CAD (63.6%).
This audit demonstrates a relatively low rate of inappropriate CCTA referrals, indicating the appropriate and efficient use of this resource in the Mohammed bin Khalifa Cardiac Center. Agreement on and reclassification of "uncertain" cases by guideline authorities would facilitate a deeper understanding of referral appropriateness.
鉴于临床环境中对冠状动脉计算机断层扫描血管造影（CCTA）过度使用的担忧日益增加，包括美国心脏病学会基金会在内的多个学会联合发布了关于该成像方式合理使用的修订标准。然而，先前的研究表明在遵循这些指南的比率方面存在显著差异。
评估巴林一家三级心脏中心CCTA转诊的合理性。
这项回顾性临床审计检查了2015年4月1日至2015年12月31日期间在穆罕默德·本·哈利法心脏中心转诊接受CCTA检查的患者记录。利用病历中的信息，对照指南对每个病例进行细致审计，将其分类为合适、不合适或不确定。
在检查的234份记录中，176份（75.2%）是合适的，47份（20.1%）不确定，11份（4.7%）不合适。所有转诊中约74.4%是为了调查冠状动脉疾病（CAD）。被认为合适的最常见指征是在CAD预测试概率中等的疑似缺血等效情况下检测CAD（65.9%）。大多数被认为不合适的转诊是要求在CAD低风险或中等风险的无症状患者中检测CAD（63.6%）。
这项审计表明CCTA转诊不合适的比率相对较低，表明在穆罕默德·本·哈利法心脏中心对这一资源的使用是合适且有效的。指南制定机构对“不确定”病例达成共识并重新分类将有助于更深入地理解转诊的合理性。
