CT 成像史对因肾绞痛就诊于急诊科的患者——多医院数据库的证据。
CT imaging history for patients presenting to the ED with renal colic--evidence from a multi-hospital database.
机构信息
Department of Emergency Medicine, CHRISTUS Health/Texas A&M School of Medicine, Corpus Christi, TX, USA.
Texas Tech University School of Medicine, Bullock, Lubbock, TX, USA.
出版信息
BMC Emerg Med. 2019 Mar 1;19(1):24. doi: 10.1186/s12873-019-0232-7.
BACKGROUND
Patients with renal colic have a 7% chance of annual recurrence. Previous studies evaluating cumulative Abbreviations: computed tomography (CT) exposure for renal colic patients were typically from single centers.
METHODS
This was an observational cohort study. Inner-city ED patients with a final diagnosis of renal colic were prospectively identified (1/10/16-10/16/16). Authors conducted structured electronic record reviews from a 6-hospital system encompassing over 192,000 annual ED visits. Categorical data analyzed by chi-square; continuous data by t-tests. Primary outcome measure was the proportion of study group patients with prior history CT abdomen/pelvis CT.
RESULTS
Two hundred thirteen patients in the study group; 59% male, age 38+/- 10 years, 67% Hispanic, 62% prior stone history, flank pain (78%), dysuria (22%), UA (+) blood (75%). 60% (95% CI = 53-66%) of patients received an EDCV CT; hydronephrosis seen in 55% (95% CI = 46-63%), stone in 90%(95% CI = 83-94%). No significant differences observed in the proportion of EDCV patients who received CT with respect to: female vs. male (62% vs. 56%; p = 0.4), mean age (37+/- 9 years vs. 39+/- 11 years; p = 0.2), and Hispanic vs. non-Hispanic white (63% vs.63%; p = 0.96). Patients with a prior stone history were more likely than those with no history to receive an EDCV CT (88% vs. 16%; p < 0.001). 118 (55%; 95% CI = 49-62%) of patients had at least one prior CT, 46 (22%; 95% CI = 16-28%) had ≥3 prior CTs; 29 (14%; 95% CI = 10-19%), ≥ 10 prior CTs. Patients who did not receive an EDCV CT had a significantly higher mean prior number of CTs than those who had EDCV CT (5.1+/- 7.7 vs 2.2+/- 4.9; p < 0.001). Patients with prior stone were more likely to receive only U/S during EDCV (33% vs. 15%; p = 0.003).
CONCLUSIONS
Within our EDCV cohort of renal colic patients, 55% had at least one prior CT. The mean number of prior CTs was lower for patients receiving CT on EDCV, and Ultrasound (US) alone was used more often in patients with prior stone history vs. those with no prior history.
背景
患有肾绞痛的患者每年有 7%的复发几率。以往评估肾绞痛患者累积 CT 暴露情况的研究通常来自单一中心。
方法
这是一项观察性队列研究。内城急诊患者的最终诊断为肾绞痛，前瞻性地确定了（1/10/16-10/16/16）。作者从一个涵盖超过 192000 次年度急诊就诊的 6 家医院系统中进行了结构化电子病历回顾。使用卡方检验分析分类数据；使用 t 检验分析连续数据。主要结局指标是研究组中既往有腹部/骨盆 CT 史的患者比例。
结果
研究组共 213 例患者；59%为男性，年龄 38+/-10 岁，67%为西班牙裔，62%有结石病史，腰痛（78%），尿痛（22%），尿酸性（75%）。60%（95%CI=53-66%）的患者接受了 EDCV CT；55%（95%CI=46-63%）的患者有肾积水，90%（95%CI=83-94%）的患者有结石。在接受 EDCV CT 的患者中，无论女性与男性（62%与 56%；p=0.4）、平均年龄（37+/-9 岁与 39+/-11 岁；p=0.2）或西班牙裔与非西班牙裔白人（63%与 63%；p=0.96），接受 CT 的比例均无显著差异。有结石病史的患者比无结石病史的患者更有可能接受 EDCV CT（88%与 16%；p<0.001）。118 例（55%；95%CI=49-62%）患者至少有一次既往 CT，46 例（22%；95%CI=16-28%）有≥3 次既往 CT，29 例（14%；95%CI=10-19%）有≥10 次既往 CT。未接受 EDCV CT 的患者的平均既往 CT 数量明显高于接受 EDCV CT 的患者（5.1+/-7.7 与 2.2+/-4.9；p<0.001）。有结石病史的患者在 EDCV 期间更有可能仅接受 US（33%与 15%；p=0.003）。
结论
在我们的 EDCV 肾绞痛患者队列中，55%的患者至少有一次既往 CT。接受 EDCV CT 的患者既往 CT 数量平均较少，且有结石病史的患者与无结石病史的患者相比，更多地使用 US 进行诊断。
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