24/7 内部超声技师随时可用的教学医院中急性阑尾炎的影像学诊断方法：申请时间对影像学方式的影响。

Imaging Approach to the Diagnosis of Acute Appendicitis in a Group of Teaching Hospitals With 24/7 In-house Availability of Ultrasound Technologist: Effect of Timing of Request on Imaging Modality.

机构信息

Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada; Medical Imaging Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia.

Joint Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.

出版信息

Can Assoc Radiol J. 2018 Aug;69(3):311-315. doi: 10.1016/j.carj.2018.03.002. Epub 2018 Jun 27.

DOI:10.1016/j.carj.2018.03.002

PMID:29958834

Abstract

PURPOSE

The study sought determine effect of requisition timing on the initial-choice imaging modality in appendicitis evaluation.

METHODS

This was an institutional review board-approved retrospective study, encompassing 3 University of Toronto teaching hospitals, offering 24/7 radiology coverage. All surgically proven appendicitis cases, from 2012-2014, were included and presurgical ultrasound (US) or computed tomography (CT) reports were analysed. Examinations were all requested by the emergency department, performed by the same technologists and reviewed or finalized by the same radiology group (residents fellows or attending). Two coverage categories, namely regular hours (8 am-5 pm, Monday-Friday) or after hours (5 pm-8 am, Monday-Friday and weekends) were compared. The percentage of the starting modality (US or CT), the rate of CT following an indeterminate US, and the sensitivity of each modality was compared between the 2 categories, utilising Mann-Whitney U and chi-square tests.

RESULTS

Presurgical US or CT studies of 494 patients, from February 2012-August 2014, were evaluated. Regular-hours and after-hours coverage demonstrated 174 (89:85 women:men) and 320 (141:179 women:men; P < .04) patients. The average age, 37.9 ± 17.1 women versus 35.2 ± 13.7 men was not statistically different (P = .8). Regular hours included 89 of 174 (51.1%) of US-only examinations, 50 of 174 (29%) of CT-only examinations, and 35 of 174 (20%) of US examinations followed by CT examinations. After hours included 147 of 320 (46%) of US-only examinations, 147 of 320 (46%) of CT-only examinations, and 26 of 320 (8%) of US examinations followed by CT examinations (P < .001). The total diagnostic sensitivities for US and CT were 86% (81% regular hours, 90% after hours; P = .041) and 99.2% (100% regular hours, 99% after hours; P > .05), respectively.

CONCLUSIONS

US was less utilised in acute appendicitis detection after hours, although its diagnostic sensitivity was better than regular-hours coverage.

摘要

目的

本研究旨在确定申请时机对阑尾炎评估初始选择影像学方式的影响。

方法

这是一项经过机构审查委员会批准的回顾性研究，涵盖了多伦多大学的 3 所教学医院，提供 24/7 放射学服务。纳入了所有经手术证实的阑尾炎病例，时间范围为 2012 年至 2014 年，并对术前超声（US）或计算机断层扫描（CT）报告进行了分析。所有检查均由急诊科申请，由同一位技师进行检查，并由同一家放射科小组（住院医师、研究员或主治医生）进行检查或最终检查。比较了两个覆盖类别，即常规时间（周一至周五 8 点至下午 5 点）和非工作时间（周一至周五下午 5 点至 8 点以及周末）。利用 Mann-Whitney U 检验和卡方检验比较了两种情况下初始选择的检查方式（US 或 CT）的百分比、不确定的 US 后行 CT 的比例以及每种方式的敏感性。

结果

评估了 2012 年 2 月至 2014 年 8 月期间 494 例患者的术前 US 或 CT 检查。常规工作时间和非工作时间的覆盖范围分别为 174 例（89 例女性：85 例男性）和 320 例（141 例女性：179 例男性；P<.04）。女性平均年龄为 37.9±17.1 岁，男性平均年龄为 35.2±13.7 岁，差异无统计学意义（P=.8）。常规时间组包括 174 例 US 检查中 89 例（51.1%）、174 例 CT 检查中 50 例（29%）和 174 例 US 检查后行 CT 检查的 35 例。非工作时间组包括 320 例 US 检查中 147 例（46%）、320 例 CT 检查中 147 例（46%）和 320 例 US 检查后行 CT 检查的 26 例（8%）（P<.001）。US 和 CT 的总诊断敏感性分别为 86%（常规时间 81%，非工作时间 90%；P=.041）和 99.2%（常规时间 100%，非工作时间 99%；P>.05）。