无国界 CT：肯尼亚农村教学医院和美国学术医疗中心腹痛诊断的比较。
CT without borders: Comparison of diagnoses for abdominal pain from a teaching hospital in rural Kenya and a US academic medical center.
机构信息
University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.
出版信息
Abdom Radiol (NY). 2023 Jun;48(6):2196-2205. doi: 10.1007/s00261-023-03869-2. Epub 2023 Mar 20.
PURPOSE
Radiology global health opportunities are expanding as more hospitals in low- and middle-income countries utilize CT. This creates opportunities for global health program building, education, service, and research. This study determines the diagnostic yield and variety of abdominopelvic CT diagnoses for abdominal pain in a US academic medical center (UW) compared to a rural Kenyan teaching hospital (Tenwek).
METHODS
A retrospective, cross-sectional sequential sample of 750 adults from both hospitals who underwent abdominopelvic CT for abdominal pain from February 2019 through July 2020 was obtained. Exclusion criteria were trauma, cancer staging, and recent hospitalization or surgery. Patient age, sex, comparison studies, use of contrast, known cancer diagnosis, and CT diagnoses were compared. Negative exam rate, acute abdomen diagnosis, and new cancer diagnosis were recorded. Statistical analysis was performed using R.
RESULTS
750 UW patients met inclusion criteria (mean age 53.3 ± 20 years; 442 women) and 750 Tenwek patients met inclusion criteria (mean age 52.5 ± 18 years; 394 women). 72% of UW patients had comparison imaging compared to 6% of Tenwek patients. 11% (83/750) of UW patients had a known cancer diagnosis compared to 1% (10/750) of Tenwek patients. 39% of UW patients had a negative exam compared to 23% of Tenwek patients (p < 0.001). 58% of UW patients had an acute abdomen diagnosis compared to 38% of Tenwek patients (p < 0.001). 10 of the 15 top acute abdomen diagnoses were shared, but in different order of frequency. Diagnoses unique to UW were diverticulitis, constipation, stercoral colitis, and epiploic appendagitis. Diagnoses unique to Tenwek were tuberculosis and hydatidosis. 3% of UW patients received a new cancer diagnosis (7/19 metastatic), compared to 40% of Tenwek patients (153/303 metastatic) (p < 0.001).
CONCLUSION
For adults undergoing CT for abdominal pain, there are differences in the prevalence of abdominal pain diagnoses, new cancer diagnosis, and negative exam rate between the rural Kenyan teaching hospital and the US academic medical center.
目的
随着越来越多的中低收入国家的医院开始使用 CT，放射学的全球健康机会正在扩大。这为全球卫生项目的建立、教育、服务和研究提供了机会。本研究旨在比较美国学术医疗中心（UW）和肯尼亚农村教学医院（Tenwek）接受 CT 检查的腹痛患者的诊断结果，并确定其诊断率和腹部盆腔 CT 诊断的种类。
方法
回顾性、横截面、连续采集了 2019 年 2 月至 2020 年 7 月期间因腹痛在两家医院接受腹部盆腔 CT 检查的 750 名成年人的样本。排除标准为创伤、癌症分期、近期住院或手术。比较了患者的年龄、性别、对比研究、使用造影剂、已知癌症诊断和 CT 诊断。记录阴性检查率、急性腹痛诊断和新的癌症诊断。使用 R 进行统计分析。
结果
750 名 UW 患者符合纳入标准（平均年龄 53.3±20 岁；442 名女性），750 名 Tenwek 患者符合纳入标准（平均年龄 52.5±18 岁；394 名女性）。72%的 UW 患者有对比成像，而 Tenwek 患者仅为 6%。11%（83/750）的 UW 患者有已知的癌症诊断，而 Tenwek 患者为 1%（10/750）。39%的 UW 患者的检查结果为阴性，而 Tenwek 患者的这一比例为 23%（p<0.001）。58%的 UW 患者为急性腹痛诊断，而 Tenwek 患者为 38%（p<0.001）。15 种最常见的急性腹痛诊断中有 10 种是共同的，但频率顺序不同。UW 特有的诊断是憩室炎、便秘、粪石性结肠炎和阑尾炎。Tenwek 特有的诊断是结核病和包虫病。UW 患者有 3%（7/19 例转移性）接受了新的癌症诊断，而 Tenwek 患者为 40%（153/303 例转移性）（p<0.001）。
结论
对于因腹痛接受 CT 检查的成年人，农村肯尼亚教学医院和美国学术医疗中心的腹痛诊断、新发癌症诊断和阴性检查率存在差异。
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