计算机辅助报告和决策支持提高了肾上腺意外瘤随访影像学和激素筛查的依从性。

Computer-assisted Reporting and Decision Support Increases Compliance with Follow-up Imaging and Hormonal Screening of Adrenal Incidentalomas.

机构信息

Radiology Department, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (R.R.A.); MGH & BWH Center for Clinical Data Science, Suite 1303, 100 Cambridge St, Boston, MA 02114 (R.R.A., B.C.B., K.P.A., T.K.A.).

MGH & BWH Center for Clinical Data Science, Suite 1303, 100 Cambridge St, Boston, MA 02114 (R.R.A., B.C.B., K.P.A., T.K.A.); Radiology Department, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (B.C.B., R.S., T.K.A.).

出版信息

Acad Radiol. 2022 Feb;29(2):236-244. doi: 10.1016/j.acra.2021.01.019. Epub 2021 Feb 12.

DOI:10.1016/j.acra.2021.01.019

PMID:33583714

Abstract

OBJECTIVE

To assess the impact of using a computer-assisted reporting and decision support (CAR/DS) tool at the radiologist point-of-care on ordering provider compliance with recommendations for adrenal incidentaloma workup.

METHOD

Abdominal CT reports describing adrenal incidentalomas (2014 - 2016) were retrospectively extracted from the radiology database. Exclusion criteria were history of cancer, suspected functioning adrenal tumor, dominant nodule size < 1 cm or ≥ 4 cm, myelolipomas, cysts, and hematomas. Multivariable logistic regression models were employed to predict follow-up imaging (FUI) and hormonal screening orders as a function of patient age and sex, nodule size, and CAR/DS use. CAR/DS reports were compared to conventional reports regarding ordering provider compliance with, frequency, and completeness of, guideline-warranted recommendations for FUI and hormonal screening of adrenal incidentalomas using Chi-square test.

RESULT

Of 174 patients (mean age 62.4; 51.1% women) with adrenal incidentalomas, 62% (108/174) received CAR/DS-based recommendations versus 38% (66/174) unassisted recommendations. CAR/DS use was an independent predictor of provider compliance both with FUI (Odds Ratio [OR]=2.47, p = 0.02) and hormonal screening (OR=2.38, p = 0.04). CAR/DS reports recommended FUI (97.2%,105/108) and hormonal screening (87.0%,94/108) more often than conventional reports (respectively, 69.7% [46/66], 3.0% [2/66], both p <0.0001). CAR/DS recommendations more frequently included instructions for FUI time, protocol, and modality than conventional reports (all p <0.001).

CONCLUSION

Ordering providers were at least twice as likely to comply with report recommendations for FUI and hormonal evaluation of adrenal incidentalomas generated using CAR/DS versus unassisted reporting. CAR/DS-directed recommendations were more adherent to guidelines than those generated without.

摘要

目的

评估在放射科医生即时决策时使用计算机辅助报告和决策支持（CAR/DS）工具对肾上腺意外瘤检查建议执行情况的影响。

方法

从放射学数据库中回顾性提取 2014 年至 2016 年描述肾上腺意外瘤的腹部 CT 报告。排除标准为癌症病史、疑似功能性肾上腺肿瘤、优势结节直径<1cm 或≥4cm、骨髓脂肪瘤、囊肿和血肿。采用多变量逻辑回归模型预测随访影像学（FUI）和激素筛查医嘱与患者年龄和性别、结节大小以及 CAR/DS 使用之间的关系。采用卡方检验比较 CAR/DS 报告与传统报告在遵循、频率和完整程度方面对肾上腺意外瘤 FUI 和激素筛查的指南推荐的符合情况。

结果

174 例肾上腺意外瘤患者（平均年龄 62.4 岁；51.1%为女性）中，62%（108/174）接受了基于 CAR/DS 的建议，而 38%（66/174）接受了无辅助建议。CAR/DS 使用是 FUI（优势比[OR]=2.47，p=0.02）和激素筛查（OR=2.38，p=0.04）的独立预测因素。CAR/DS 报告推荐 FUI（97.2%，105/108）和激素筛查（87.0%，94/108）的频率高于传统报告（分别为 69.7%[46/66]和 3.0%[2/66]，均 p<0.0001）。CAR/DS 报告比传统报告更频繁地包含 FUI 时间、方案和方式的说明（均 p<0.001）。