Edward B. Singleton Department of Pediatric Radiology, Texas Children's Hospital, 6701 Fannin St., Suite 470, Houston, TX, 77030, USA.
Department of Radiology, San Antonio Military Medical Center, Fort Sam, Houston, TX, USA.
Pediatr Radiol. 2020 Jul;50(8):1095-1101. doi: 10.1007/s00247-020-04659-4. Epub 2020 Apr 3.
Demand for pediatric cardiac computed tomography (CT) angiography is increasing due to recent advances that reduce the need for sedation and radiation exposure while enhancing diagnostic accuracy. This has resulted in the increasing use of cardiac CT angiography emergently during weekends and after hours. The unexpected demand for these services can be challenging, as most hospitals are not staffed to provide 24/7 pediatric cardiovascular imaging.
To describe a large single-center experience of providing emergent cardiac CT angiography services in children.
We identified all patients who underwent after--hours weekday and weekend emergent cardiac CT angiography between January 2017 and August 2018. Cardiac CT angiography in the settings of congenital heart disease and coronary imaging were included. Data collected included day and time of cardiac CT angiography, patient age, referral unit, indication, surgical history, need for sedation, need for surgery, intervention and/or change in medical management based on the cardiac CT angiography.
Forty-seven studies were identified, 26 (55%) of which were performed on a weekend or holiday and 21 (45%) after 5 p.m. on a weekday. Based on cardiac CT angiography findings, 20 (43%) patients underwent either surgery or an interventional procedure, and 9 (19%) had a change in medical management. The time between cardiac CT angiography and the related surgery/intervention ranged from 0 to 29 days with a median of 3.5 days.
Emergent pediatric cardiac CT angiography is a valuable service. Larger multi-institutional studies with standardized referral and utilization patterns are needed to determine if outcomes are affected by this service, which in turn will influence hospital staffing patterns for emergent imaging.
由于最近的技术进步，减少了镇静和辐射暴露的需求，同时提高了诊断准确性，儿科心脏 CT 血管造影（CTA）的需求不断增加。这导致了在周末和下班后越来越多地紧急使用心脏 CTA。由于大多数医院没有配备人员来提供 24/7 儿科心血管成像服务，因此对这些服务的意外需求具有挑战性。
描述一家大型单中心在儿童中提供紧急心脏 CTA 服务的经验。
我们确定了在 2017 年 1 月至 2018 年 8 月期间在工作日和周末进行的所有下班后紧急心脏 CTA 检查的患者。包括先天性心脏病和冠状动脉成像的心脏 CTA。收集的数据包括心脏 CTA 的日期和时间、患者年龄、转诊单位、适应症、手术史、镇静的需求、手术的需求、根据心脏 CTA 进行的介入和/或医疗管理的改变。
共确定了 47 项研究，其中 26 项（55%）在周末或假日进行，21 项（45%）在工作日下午 5 点后进行。根据心脏 CTA 结果，20 名（43%）患者进行了手术或介入治疗，9 名（19%）患者的医疗管理发生了改变。心脏 CTA 与相关手术/介入之间的时间间隔从 0 到 29 天，中位数为 3.5 天。
紧急儿科心脏 CTA 是一项有价值的服务。需要更大规模的多机构研究，制定标准化的转诊和利用模式，以确定该服务是否会影响结果，这反过来又会影响紧急成像的医院人员配备模式。
