Klein Robert Peter, Velan Gary, Young Noel, Shetty Amith, Moscova Michelle
Faculty of Medicine & Health, University of New South Wales, Sydney, NSW, 2052, Australia.
Department of Radiology, Westmead Hospital, Darcy Rd, Westmead, NSW, 2145, Australia.
Emerg Radiol. 2021 Aug;28(4):761-770. doi: 10.1007/s10140-021-01921-6. Epub 2021 Feb 26.
The current study aimed to evaluate the appropriateness of the decisions made to order diagnostic imaging for emergency trauma patients.
A retrospective audit of 642 clinical decisions for 370 non-consecutive trauma cases was conducted at a level 1 adult trauma centre. Radiographs and computed tomography investigations were compared for compliance with the American College of Radiology/European Society of Radiology (ACR/ESR) imaging guidelines. The non-compliant imaging orders were evaluated for the following medical officer ranks: Junior Medical Officer (JMO), Senior Resident Medical Officer (SRMO), Emergency Medicine Registrar (EMR) and Consultants/Career Medical Officer (CMO). The time of imaging order (day/evening or night shift), whether the imaging led to conservative or surgical patient management, and whether the imaging order decisions led to a change in the clinical management of the patient were also considered.
Non-compliance with the ACR/ESR guidelines was low. At least half of non-compliant decisions made by each level of medical officer resulted in a change in patient management. In total, 11 (65%), 25 (53%), 12 (63%) and 11 (52%) of non-compliant imaging orders placed by JMOs, SRMOs, EMRs and Consultants, respectively, resulted in change of patient management. JMOs and SRMOs ordered a significantly higher proportion of non-compliant imaging studies for conservatively managed patients in comparison to surgically managed patients.
This study highlighted that most non-compliant imaging orders benefited the patient.
本研究旨在评估为急诊创伤患者开具诊断性影像学检查的决策是否恰当。
在一家一级成人创伤中心，对370例非连续性创伤病例的642项临床决策进行了回顾性审计。将X线片和计算机断层扫描检查结果与美国放射学会/欧洲放射学会（ACR/ESR）影像学指南进行对照。对不符合指南的影像学检查医嘱，按以下医务人员级别进行评估：初级医务人员（JMO）、高级住院医师（SRMO）、急诊医学住院医师（EMR）以及顾问医师/职业医务人员（CMO）。还考虑了开具影像学检查医嘱的时间（白班/晚班或夜班）、影像学检查是否导致患者采取保守或手术治疗，以及影像学检查医嘱决策是否导致患者临床治疗方案的改变。
不符合ACR/ESR指南的情况较少。各级医务人员做出的至少一半不符合指南的决策导致了患者治疗方案的改变。JMO、SRMO、EMR以及顾问医师分别开具的不符合指南的影像学检查医嘱中，分别有11项（65%）、25项（53%）、12项（63%）和11项（52%）导致了患者治疗方案的改变。与接受手术治疗的患者相比，JMO和SRMO为接受保守治疗的患者开具的不符合指南的影像学检查比例显著更高。
本研究强调，大多数不符合指南的影像学检查医嘱对患者有益。
