对计算机断层扫描指征的批判性反思：脓毒症患者风险与获益管理的跨学科调查

Critical reflection on the indication for computed tomography: an interdisciplinary survey of risk and benefit management in patients with sepsis.

作者信息

Opper Hernando Maria Isabel, Witham Denis, Stahl Ann-Christine, Steinhagen Peter Richard, Angermair Stefan, Bauer Wolfgang, Compton Friederike, Edel Andreas, Kruse Jan Matthias, Kühnle York, Lachmann Gunnar, Marz Susanne, Müller-Redetzky Holger, Nee Jens, Paul Oliver, Praeger Damaris, Skurk Carsten, Stegemann Miriam, Uhrig Alexander, Wolf Stefan, Bolanaki Myrto, Rubarth Kerstin, Seybold Joachim, Zimmermann Elke, Dewey Marc, Pohlan Julian

机构信息

Department of Radiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1, Berlin, Germany.

Department of Cardiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1, Berlin, Germany.

出版信息

Insights Imaging. 2025 Jan 13;16(1):15. doi: 10.1186/s13244-024-01894-3.

DOI:10.1186/s13244-024-01894-3

PMID:39804413

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11730041/

Abstract

OBJECTIVES

To survey physicians' views on the risks and benefits of computed tomography (CT) in the management of septic patients and indications for and contraindications to contrast media use in searching for septic foci.

METHODS

A web-based questionnaire was administered to physicians at a large European university medical center in January 2022. A total of 371 questionnaires met the inclusion criteria and were analyzed with physicians' work experience, workplace, and medical specialty as independent variables. Chi-square tests were used for exploratory analysis.

RESULTS

While physicians with all levels of work experience were included, the largest group (35.0%, n = 130/371) had 3-7 years of experience. Most physicians agreed that the benefits of CT outweigh its potential adverse effects in septic patients (90.5%, n = 336/371). Responders saw the strongest indication for contrast media administration in septic patients for (1) CT examinations of the abdomen (92.7%, n = 333/359) and (2) combined CT examinations of the chest, abdomen, and pelvis (94.1%, n = 337/358). While radiologists were most likely to consider manifest hyperthyroidism an absolute contraindication to contrast media administration (43.8%, n = 14/32), most other groups of physicians opted for appropriate preparation before contrast media administration in this subset of septic patients.

CONCLUSION

In this survey, most participating physicians considered CT an essential diagnostic modality to detect an infectious focus in septic patients. Whereas the risk of ionizing radiation was regarded as justifiable by most physicians, different specialties varied in their assessment of the risks of contrast media administration.

KEY POINTS

Physicians recognize CT as a relevant imaging modality in the diagnostic management of patients with sepsis. There is an interdisciplinary consensus that the use of ionizing radiation is justified in septic patients. There is disagreement about indications for and contraindications to contrast media administration among physicians from different medical specialties.

摘要

目的

调查医生对计算机断层扫描（CT）在脓毒症患者管理中的风险和益处的看法，以及在寻找脓毒症病灶时使用造影剂的适应证和禁忌证。

方法

2022年1月，在一所大型欧洲大学医学中心对医生进行了一项基于网络的问卷调查。共有371份问卷符合纳入标准，并以医生的工作经验、工作场所和医学专业作为自变量进行分析。采用卡方检验进行探索性分析。

结果

虽然纳入了各级工作经验的医生，但最大的一组（35.0%，n = 130/371）有3至7年的工作经验。大多数医生认为，CT对脓毒症患者的益处大于其潜在的不良反应（90.5%，n = 336/371）。受访者认为脓毒症患者使用造影剂的最强适应证为：（1）腹部CT检查（92.7%，n = 333/359）和（2）胸部、腹部和骨盆联合CT检查（94.1%，n = 337/358）。虽然放射科医生最有可能将明显的甲状腺功能亢进视为造影剂使用的绝对禁忌证（43.8%，n = 14/32），但大多数其他医生群体选择在这部分脓毒症患者中在使用造影剂前进行适当准备。