The DAMASK trial protocol: a pragmatic randomised trial to evaluate whether GPs should have direct access to MRI for patients with suspected internal derangement of the knee.
The DAMASK trial protocol: a pragmatic randomised trial to evaluate whether GPs should have direct access to MRI for patients with suspected internal derangement of the knee.
复制标题
Damask试验方案：一项务实的随机试验，用于评估GP是否应直接访问膝关节内部危险的患者MRI。
DOI：
10.1186/1472-6963-6-133
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发表时间：
2006-10-13
影响因子：
2.8
通讯作者：
Wilkinson, Clare
中科院分区：
文献类型：
--
作者：
Brealey, Stephen D;Atwell, Christine;Bryan, Stirling;Coulton, Simon;Cox, Helen;Cross, Ben;Fylan, Fiona;Garratt, Andrew;Gilbert, Fiona J;Gillan, Maureen G C;Hendry, Maggie;Hood, Kerenza;Houston, Helen;King, David;Morton, Veronica;Orchard, Jo;Robling, Michael;Russell, Ian T;Torgerson, David;Wadsworth, Valerie;Wilkinson, Clare
虽然磁共振成像（MRI）等新技术可能是准确的，但它们通常在对其诊断和管理价值以及对患者结局和成本的影响进行全面评估之前就已扩散到实践中。膝关节MRI是一种常见的检查，尽管担心它并不总是合适的。全科医生（GP）获得和使用MRI以及相关费用存在很大差异。本研究的目的是解决不确定性，是否全科医生应转介患者怀疑内部紊乱的膝关节进行MRI或骨科专家在二级保健。该设计包括一个实用的多中心随机试验，两个平行组和伴随的经济评价。在全科诊所就诊的疑似膝关节内部紊乱的患者，以及他们的全科医生正在考虑转诊至二级护理的骨科专家的患者有资格入选。在实践中，全科医生或实习护士将合格且同意的参与者随机分配到当地放射科进行MRI检查，或咨询骨科专家。为了确保两个试验组从全科医生咨询到骨科预约的等待时间相似，全科医生在要求进行MRI检查时临时转诊到骨科。因此，我们评估了更合适的事件顺序独立于等待时间的变化。在随机化后6个月、12个月和24个月通过邮寄问卷对参与者进行随访。这是为了确保评价涵盖关节镜检查之前的所有事件。DAMASK试验应该为初级和二级保健专业人员之间基于证据的伙伴关系的发展做出重大贡献，并为MRI何时进入诊断途径的辩论提供信息。
Though new technologies like Magnetic Resonance Imaging (MRI) may be accurate, they often diffuse into practice before thorough assessment of their value in diagnosis and management, and of their effects on patient outcome and costs. MRI of the knee is a common investigation despite concern that it is not always appropriate. There is wide variation in general practitioners (GPs) access to, and use of MRI, and in the associated costs. The objective of this study was to resolve uncertainty whether GPs should refer patients with suspected internal derangement of the knee for MRI or to an orthopaedic specialist in secondary care. The design consisted of a pragmatic multi-centre randomised trial with two parallel groups and concomitant economic evaluation. Patients presenting in general practice with suspected internal derangement of the knee and for whom their GP was considering referral to an orthopaedic specialist in secondary care were eligible for inclusion. Within practices, GPs or practice nurses randomised eligible and consenting participants to the local radiology department for an MRI examination, or for consultation with an orthopaedic specialist. To ensure that the waiting time from GP consultation to orthopaedic appointment was similar for both trial arms, GPs made a provisional referral to orthopaedics when requesting the MRI examination. Thus we evaluated the more appropriate sequence of events independent of variations in waiting times. Follow up of participants was by postal questionnaires at six, twelve and 24 months after randomisation. This was to ensure that the evaluation covered all events up to and including arthroscopy. The DAMASK trial should make a major contribution to the development of evidence-based partnerships between primary and secondary care professionals and inform the debate when MRI should enter the diagnostic pathway.