University Hospital Wales, Heath Park Way, Cardiff, CF14 4XW, United Kingdom.
J Med Imaging Radiat Sci. 2024 Jun;55(2):297-306. doi: 10.1016/j.jmir.2023.07.018. Epub 2023 Aug 10.
Previous literature reviews revealed that abdominal X-rays (AXR) performed for the accident and emergency department (A&E), had low sensitivity, high further imaging and non-alignment rate to the Royal College of Radiologists (RCR) guidelines. A study was performed to investigate the current practice with the aim of making recommendations to improve practice, which can reduce patients' radiation exposures, while can re-routing resources to other priorities.
A study was performed in one of the UK's largest A&Es, in accordance with the RCR guidelines. All the AXR requests from A&E, regardless of the patient's age, within a 28-day period, were retrospectively assessed. Non-A&E patients and abandoned examinations due to uncooperative patients were excluded. The total number of AXR requests received by the A&E imaging department was 169, with 28/169 falling into the exclusion criteria.
Of the 141 included requests, five unjustified requests were correctly rejected. The remaining 136 requests were accepted and performed, though only 115/136 (84.6%) of these were justified. The most common justified and unjustified indications were obstruction and renal stones, respectively. Only 4% of reported AXR had pathological abnormalities, while 45/136 patients had further imaging.
The small proportion of significant findings echoed previous studies, suggesting an AXR overuse. Over 80% of non-compliant requests were performed, and awareness of the justification guidelines can be increased by clinical governance, posters, or an algorithm previously presented. The 32.4% further imaging rate recorded in this study, as opposed to the 73.7% reported in previous literature, merits attention.
Stopping the overuse of AXR can minimise the radiation dose received and relieve the mounting pressure in imaging and reporting, which can serve other patients who would benefit from the services otherwise.
先前的文献综述表明，急诊科进行的腹部 X 光（AXR）检查敏感性较低，对皇家放射科医师学院（RCR）指南的进一步影像学检查和不符合率较高。进行了一项研究，以调查当前的实践情况，旨在提出建议以改善实践，从而降低患者的辐射暴露，同时将资源重新分配到其他优先事项。
在英国最大的急诊科之一，按照 RCR 指南进行了一项研究。回顾性评估了 A&E 范围内 28 天内所有 AXR 请求，无论患者年龄大小。排除非 A&E 患者和因患者不合作而放弃的检查。A&E 影像部门共收到 169 份 AXR 请求，其中 28/169 例符合排除标准。
在 141 份纳入的请求中，有 5 份无正当理由的请求被正确拒绝。其余 136 份请求被接受并进行了检查，但其中只有 115/136（84.6%）是有正当理由的。最常见的正当和不正当指征分别是梗阻和肾结石。仅 4%的报告 AXR 有病理异常，而 45/136 例患者进行了进一步影像学检查。
小比例的显著发现与先前的研究相呼应，表明 AXR 过度使用。超过 80%的不合规请求得到了执行，可以通过临床治理、海报或之前提出的算法来提高对正当性指南的认识。与先前文献报道的 73.7%相比，本研究记录的 32.4%进一步影像学检查率值得关注。
停止过度使用 AXR 可以最大限度地减少患者接受的辐射剂量，并缓解影像学检查和报告的压力，从而为其他可能受益于这些服务的患者提供服务。
