Department of Emergency Medicine, University of California, San Francisco, United States of America.
Department of Emergency Medicine, University of California, San Francisco, United States of America; Philip R Lee Institute for Health Policy Studies, University of California, San Francisco.
Am J Emerg Med. 2022 Oct;60:164-170. doi: 10.1016/j.ajem.2022.08.015. Epub 2022 Aug 10.
Previously, we found that the use of ultrasonography for patients with suspected nephrolithiasis resulted in similar outcomes and less radiation exposure vs. CT scan. In this study, we evaluated the implementation of an ultrasound-first clinical decision support (CDS) tool in patients with suspected nephrolithiasis.
This randomized trial was conducted at an academic emergency department (ED). We implemented the ultrasound-first CDS tool, deployed when an ED provider placed a CT order for suspected nephrolithiasis. Providers were randomized to receiving the CDS tool vs. usual care. The primary outcome was receipt of CT during the index ED visit. Secondary outcomes included radiation dose and ED revisit.
64 ED Providers and 254 patients with suspected nephrolithiasis were enrolled from January 2019 through Dec 2020. The US-First CDS tool was deployed for 128 patients and was not deployed for 126 patients. 86.7% of patients in the CDS arm received a CT vs. 94.4% in the usual care arm, resulting in an absolute risk difference of -7.7% (-14.8 to -0.6%). Mean radiation dose in the CDS arm was 6.8 mSv (95% CI 5.7-7.9 mSv) vs. 6.1 mSv (95% CI 5.1-7.1 mSv) in the usual care arm. The CDS arm did not result in increased ED revisits, CT scans, or hospitalizations at 7 or 30 days.
Implementation of the US-first CDS tool resulted in lower CT use for ED patients with suspected nephrolithiasis. The use of this decision support may improve the evaluation of a common problem in the ED.
ClinicalTrials.gov#NCT03461536.
此前，我们发现，对于疑似肾结石患者，超声检查的结果与 CT 扫描相似，但辐射暴露量较低。在这项研究中，我们评估了在疑似肾结石患者中使用超声优先的临床决策支持（CDS）工具的效果。
这是一项在学术急诊部（ED）进行的随机试验。当 ED 医生为疑似肾结石患者开 CT 检查单时，我们实施了超声优先的 CDS 工具。医生被随机分为接受 CDS 工具组和常规护理组。主要结局是在 ED 就诊期间接受 CT 检查。次要结局包括辐射剂量和 ED 复诊。
2019 年 1 月至 2020 年 12 月期间，共有 64 名 ED 医生和 254 名疑似肾结石患者入组。CDS 工具在 128 名患者中得到了应用，在 126 名患者中未得到应用。CDS 组中 86.7%的患者接受了 CT 检查，而常规护理组中 94.4%的患者接受了 CT 检查，绝对风险差异为-7.7%（-14.8 至-0.6%）。CDS 组的平均辐射剂量为 6.8 mSv（95%CI 5.7-7.9 mSv），常规护理组为 6.1 mSv（95%CI 5.1-7.1 mSv）。CDS 组并未导致 ED 复诊、CT 扫描或 7 天或 30 天内的住院治疗增加。
在疑似肾结石的 ED 患者中实施超声优先 CDS 工具可降低 CT 使用率。该决策支持的使用可能会改善 ED 中常见问题的评估。
ClinicalTrials.gov#NCT03461536。
