塔斯马尼亚急诊科在调查疑似肺栓塞时如何“明智选择”。
How Tasmanian Emergency Departments 'Choose Wisely' When Investigating Suspected Pulmonary Embolism.
作者信息
Thurlow Lauren E, Van Dam Pieter J, Prior Sarah J, Tran Viet
机构信息
Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS 7000, Australia.
School of Nursing, College of Health and Medicine, University of Tasmania, Burnie, TAS 7320, Australia.
出版信息
Healthcare (Basel). 2023 May 30;11(11):1599. doi: 10.3390/healthcare11111599.
Overuse of computed tomography pulmonary angiograms (CTPAs) for diagnosis of pulmonary embolism (PE) has been recognised as an issue for over ten years, with Choosing Wisely Australia recommending that CTPAs only be ordered if indicated by a clinical practice guideline (CPG). This study aimed to explore the use of evidence-based practice within regional Tasmanian emergency departments in relation to CTPA orders by determining whether CTPAs were ordered in accordance with validated CPGs. We conducted a retrospective medical record review of all patients who underwent CTPA across all public emergency departments in Tasmania between 1 August 2018 and 31 December 2019 inclusive. Data from 2758 CTPAs across four emergency departments were included. PE was reported in 343 (12.4%) of CTPAs conducted, with yield ranging from 8.2% to 16.1% between the four sites. Overall, 52.1% of participants had neither a CPG documented, nor a D-dimer conducted before their scan. A CPG was documented before 11.8% of scans, while D-dimer was conducted before 43% of CTPAs. The findings presented in this study indicate that Tasmanian emergency departments are not consistently 'Choosing Wisely' when investigating PE. Further research is required to identify explanations for these findings.
十多年来,计算机断层扫描肺动脉造影(CTPA)在诊断肺栓塞(PE)方面的过度使用一直被视为一个问题,澳大利亚明智选择组织建议仅在临床实践指南(CPG)表明有必要时才开具CTPA检查。本研究旨在通过确定CTPA检查是否符合经过验证的CPG,来探索塔斯马尼亚地区急诊科在开具CTPA检查方面基于证据的实践情况。我们对2018年8月1日至2019年12月31日(含)期间塔斯马尼亚所有公立急诊科接受CTPA检查的所有患者进行了回顾性病历审查。纳入了来自四个急诊科的2758例CTPA检查数据。在进行的CTPA检查中,343例(12.4%)报告有PE,四个地点的检出率在8.2%至16.1%之间。总体而言,52.1%的参与者在扫描前既没有记录CPG,也没有进行D-二聚体检测。11.8%的扫描前记录了CPG,而43%的CTPA检查前进行了D-二聚体检测。本研究结果表明,塔斯马尼亚急诊科在对PE进行调查时并非始终如一地“明智选择”。需要进一步研究以找出这些结果的原因。
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