Hankey G J, Stewart-Wynne E G
Department of Neurology, Royal Perth Hospital, Perth, Western Australia.
Clin Exp Neurol. 1987;23:187-90.
A one year prospective study was undertaken to evaluate the usage of the cranial CT scan in private neurological practice. The impetus for the study emanated from a general impression that patterns of referral to neurologists were changing with regard to the nature of the patients' condition and that a large number of patients had already had a cranial CT scan before neurological consultation. A total of 826 cases were reviewed. Sixty (7%) had had a recent cranial CT scan before consultation, and 90% of these cases were referred by the patients' general practitioners. A provisional diagnosis was attempted by the GP in 36% of cases, and 50% of these were correct. Ninety-five per cent of the CT scans were normal. Eighty-three (10%) patients were referred for cranial CT scan after neurological consultation. The neurologists' reasons for CT scanning included investigation of epilepsy (20%) and exclusion of a structural cerebral hemisphere lesion (16%), acoustic neuroma (10%) and other posterior fossa lesions (16%). Ninety-one per cent of these CT scans were normal. In all, 143 (17%) patients underwent cranial CT scanning; of these almost half (42%) had been referred for the CT scan by the general practitioner before neurological consultation. This study contrasts the CT scan referring patterns of general practitioners with that of a neurologist and questions the possible overuse of this facility.
开展了一项为期一年的前瞻性研究，以评估头颅CT扫描在私立神经科诊所的使用情况。该研究的动力源于一种普遍印象，即就患者病情的性质而言，转诊至神经科医生的模式正在发生变化，并且大量患者在进行神经科会诊之前已经进行过头颅CT扫描。总共审查了826例病例。其中60例（7%）在会诊前近期进行过头颅CT扫描，这些病例中有90%是由患者的全科医生转诊的。全科医生在36%的病例中尝试做出初步诊断，其中50%正确。95%的CT扫描结果正常。83例（10%）患者在神经科会诊后被转诊进行头颅CT扫描。神经科医生进行CT扫描的原因包括对癫痫的检查（20%）以及排除大脑半球结构性病变（16%）、听神经瘤（10%）和其他后颅窝病变（16%）。这些CT扫描中有91%结果正常。总共有143例（17%）患者接受了头颅CT扫描；其中近一半（42%）是在神经科会诊前由全科医生转诊进行CT扫描的。这项研究对比了全科医生和神经科医生的CT扫描转诊模式，并对该检查设备可能的过度使用提出了质疑。
