Time to diagnostic certainty for saddle pulmonary embolism in hospitalized patients.
Time to diagnostic certainty for saddle pulmonary embolism in hospitalized patients.
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DOI：
10.17305/bb.2022.8393
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发表时间：
2023-07-03
期刊：
影响因子：
--
通讯作者：
Pickering, Brian W.
中科院分区：
文献类型：
--
作者：
Pinevich, Yuliya;Barwise, Amelia K.;Austin, John Matthew;Soleimani, Jalal;Herasevich, Svetlana;Redmond, Sarah;Dong, Yue;Herasevich, Vitaly;Gajic, Ognjen;Pickering, Brian W.
关键词：
缺乏与肺栓塞（PE）相关的诊断性能指标。我们的目的是探讨诊断确定性时间的概念，我们将其定义为患者首次就诊至计算机断层扫描肺血管造影（CT PA）确诊PE诊断之间的时间间隔。这种方法可用于突出卫生系统诊断性能的变化，并选择患者离群值进行结构化图表审查，以确定诊断错误或延迟的潜在因素。我们在一个卫生系统的学术医疗中心和相关的社区医院进行了一项回顾性观察研究，检查了随机选择的被诊断为急性鞍状PE的成人患者。从340例因鞍状PE出院的患者中随机选择100例患者。24例患者被排除。在纳入的76例患者中，确诊时间范围为1.5至310小时。我们发现73/76例患者被认为在入院时存在PE（CT PA ≤ 48小时）。入院时存在PE且确诊时间> 6小时的患者比例为26%（19/73）。73例患者的中位（IQR）至治疗时间（溶栓剂/抗凝剂）为3.5（2.5-5.1）小时。入院时出现PE且治疗延迟> 6小时的患者比例为16%（12/73）。3例患者在住院期间获得PE（CT PA > 48小时）。在这项研究中，我们开发并成功地测试了鞍状PE诊断确定性的时间概念。
There is a lack of diagnostic performance measures associated with pulmonary embolism (PE). We aimed to explore the concept of the time to diagnostic certainty, which we defined as the time interval that elapses between first presentation of a patient to a confirmed PE diagnosis with computed tomography pulmonary angiogram (CT PA). This approach could be used to highlight variability in health system diagnostic performance and to select patient outliers for structured chart review in order to identify underlying contributors to diagnostic error or delay. We performed a retrospective observational study at academic medical centers and associated community-based hospitals in one health system, examining randomly selected adult patients admitted to study sites with a diagnosis of acute saddle PE. One hundred patients were randomly selected from 340 patients discharged with saddle PE. Twenty-four patients were excluded. Among the 76 included patients, time to diagnostic certainty ranged from 1.5 to 310 hours. We found that 73/76 patients were considered to have PE present on admission (CT PA ≤ 48 hours). The proportion of patients with PE present on admission with time to diagnostic certainty of > 6 hours was 26% (19/73). The median (IQR) time to treatment (thrombolytics/anticoagulants) was 3.5 (2.5–5.1) hours among the 73 patients. The proportion of patients with PE present on admission with treatment delays of > 6 hours was 16% (12/73). Three patients acquired PE during hospitalization (CT PA > 48 hours). In this study, we developed and successfully tested the concept of time to diagnostic certainty for saddle PE.
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影响因子：
2.2
作者：
Pellathy T;Saul M;Clermont G;Dubrawski AW;Pinsky MR;Hravnak M
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DOI：
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发表时间：
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