Department of Radiology, McMaster University, Hamilton, ON, Canada.
Department of Radiology, Hamilton General Hospital, 237 Barton St E, Hamilton, ON, L8L 2X2, Canada.
Abdom Radiol (NY). 2018 Nov;43(11):3176-3183. doi: 10.1007/s00261-018-1576-2.
To retrospectively assess the relative diagnostic utility of radiologist-recommended ultrasound (US) following emergency department (ED) abdominal and pelvic computed tomography (CT) in patients with non-traumatic abdominal and/or pelvic pain.
Blinded to clinical outcomes, two radiology residents and an attending radiologist reviewed radiology reports and relevant medical records for all adult patients from EDs at two academic medical centers from one institution over a 3-year time period, who underwent abdominal/pelvic US within 72 h of an initial IV contrast-enhanced abdominal and pelvic CT for non-traumatic abdominal and/or pelvic pain. Incremental diagnostic utility of subsequent US was deemed present when (1) US findings were discordant with those at CT, or (2) findings were concordant, but US yielded additional relevant diagnostic information. Diagnostic utility was stratified by whether examinations were radiologist-recommended or independently ordered by treating physicians.
319 encounters satisfied the inclusion criteria, including 194 female patients (18-98 years of age, mean of 59.8 years) and 125 male patients (20-90 years of age, mean of 63.2 years). 7 (2.2%) subsequent US examinations were discordant with the initial CT, 100 (31.3%) were concordant but provided relevant additional information, and 212 (66.5%) were concordant without providing additional information, for an overall diagnostic utility of 33.5%. Of subsequent radiologist-recommended US examinations, 70.0% (63/90) yielded incremental diagnostic utility vs. 19.2% (44/229) ordered independently by treating physicians (OR 3.65; 95% CI 2.31-5.75). For those encounters in which US provided incremental diagnostic utility, the most commonly assessed anatomical areas were the biliary system and the female adnexal region.
In ED patients with non-traumatic abdominal and/or pelvic pain undergoing abdominal and pelvic CT, follow-up US examinations recommended by radiologists are more likely to provide incremental diagnostic utility than those independently ordered by their treating physicians. In order to optimize the value of advanced imaging, radiologists should assume greater roles in team-based utilization management.
回顾性评估急诊科（ED）腹部和骨盆计算机断层扫描（CT）后，放射科医生推荐的超声（US）在非创伤性腹部和/或盆腔疼痛患者中的相对诊断效用。
两位放射科住院医师和一位主治放射科医师在一家机构的两个学术医疗中心的 ED 对所有成人患者进行了研究，这些患者在 3 年时间内接受了腹部/盆腔 US 检查，这些患者在初始 IV 对比增强腹部和骨盆 CT 后 72 小时内接受了非创伤性腹部和/或盆腔疼痛的检查。随后 US 的增量诊断效用被认为存在，当（1）US 结果与 CT 结果不一致，或（2）结果一致，但 US 提供了额外的相关诊断信息。根据检查是放射科医生推荐的还是由治疗医生独立开具，对诊断效用进行了分层。
319 次就诊符合纳入标准，包括 194 名女性患者（18-98 岁，平均 59.8 岁）和 125 名男性患者（20-90 岁，平均 63.2 岁）。7（2.2%）次后续 US 检查与初始 CT 不一致，100（31.3%）次检查结果一致但提供了额外的相关信息，212（66.5%）次检查结果一致但未提供额外信息，总体诊断效用为 33.5%。在随后的放射科医生推荐的 US 检查中，70.0%（63/90）产生了增量诊断效用，而由治疗医生独立开具的检查为 19.2%（44/229）（OR 3.65；95%CI 2.31-5.75）。在那些 US 提供增量诊断效用的就诊中，最常评估的解剖区域是胆道系统和女性附件区域。
在接受腹部和骨盆 CT 检查的非创伤性腹部和/或盆腔疼痛的 ED 患者中，放射科医生推荐的后续 US 检查比由治疗医生独立开具的检查更有可能提供增量诊断效用。为了优化高级影像学的价值，放射科医生应在基于团队的利用管理中发挥更大的作用。
