Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, and Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Australia.
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, and Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Australia.
Clin Radiol. 2022 Jun;77(6):428-435. doi: 10.1016/j.crad.2022.02.011. Epub 2022 Mar 30.
To synthesise the available evidence about the effects of modifications to diagnostic imaging reports that aim to optimise patient care.
Cochrane methods were used and CENTRAL, MEDLINE, EMBASE, and clinical trials registers were searched from inception to 31 March 2021. Randomised controlled trials of modifications to imaging reports aimed at optimising patient care for any condition were included. Two authors selected studies independently for inclusion, extracted data, assessed risk of bias, and judged certainty of evidence using GRADE. The primary outcome was quality of care (e.g., increased guideline-adherent care, reduced/increased imaging as appropriate).
Five trials met eligibility criteria. One tested provision of information about appropriate osteoporosis treatment in bone density reports; two tested provision of criteria and treatment for heart failure in echocardiogram reports; one tested provision of reminders for when routine imaging is not needed in lumbar spine and knee radiography reports; and one tested inclusion of epidemiological data in lumbar spine imaging reports. All trials were susceptible to bias, and four did not blind all participants. Low certainty evidence from two trials found adding information about appropriate care may increase care quality compared to a standard report (RR 1.20 (95% CI 0.96 to 1.50), two trials, 1,548 participants, I = 49). This was supported by outcomes of two additional trials that also provided specific clinical guidance.
The present review suggests that providing specific guidance on appropriate clinical intervention in imaging reports may improve patient care. Further high-quality trials are needed to confirm these findings. Prospective PROSPERO registration CRD42020153961.
综合关于旨在优化患者护理的诊断影像学报告修改的现有证据。
使用 Cochrane 方法，从创建到 2021 年 3 月 31 日，在 Cochrane 中心对照试验注册库、MEDLINE、EMBASE 和临床试验注册库中进行检索。纳入旨在优化任何疾病患者护理的影像学报告修改的随机对照试验。两位作者独立选择纳入的研究、提取数据、评估偏倚风险，并使用 GRADE 评估证据确定性。主要结局是护理质量（例如，增加符合指南的护理，适当减少/增加影像学检查）。
五项试验符合入选标准。一项试验测试了在骨密度报告中提供有关适当骨质疏松治疗信息的效果；两项试验测试了在超声心动图报告中提供心力衰竭标准和治疗信息的效果；一项试验测试了在腰椎和膝关节 X 光报告中提供常规影像学检查无需进行的提醒的效果；一项试验测试了在腰椎影像学报告中纳入流行病学数据的效果。所有试验都容易受到偏倚的影响，四项试验没有对所有参与者进行盲法。两项试验的低确定性证据表明，与标准报告相比，添加有关适当护理的信息可能会提高护理质量（RR 1.20（95% CI 0.96 至 1.50），两项试验，1548 名参与者，I²=49%）。这得到了另外两项试验的结果的支持，这两项试验也提供了具体的临床指导。
本综述表明，在影像学报告中提供关于适当临床干预的具体指导可能会改善患者护理。需要进一步开展高质量的试验来证实这些发现。前瞻性 PROSPERO 注册 CRD42020153961。
