Stroke Imaging: Quantity, But is There Quality?
Stroke Imaging: Quantity, But is There Quality?
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中风影像：数量，但有质量吗？
DOI：
10.1097/mlr.0000000000000538
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发表时间：
2016
期刊：
影响因子：
3
通讯作者：
Burke,JamesF
中科院分区：
文献类型：
--
作者：
Levine,DeborahA;Burke,JamesF
诊断测试是临床护理的常规部分，占临床工作量和成本的相当大的一部分。我们通常通过检查这些护理过程而不是其结果来评估医疗护理的质量。然而，“好”医疗的证据基础，即使是指南推荐的医疗，往往比我们意识到的要弱。1这对于诊断测试尤其如此，这些测试仅通过改变决策和管理来间接影响结果。因此，在常规临床实践中，基本问题没有被提出或回答：我们为什么要进行测试？我们应该测试谁？这些问题，虽然不是没有问过，但大多数中风诊断测试基本上没有答案。每年，全世界有数百万人遭受中风，其中80%-87%是缺血性的。临床实践指南建议对疑似或确诊的卒中和短暂性脑缺血发作（TIA）进行几种影像学检查，包括轴向脑成像[例如，计算机断层扫描（CT）或磁共振成像（MRI）]、血管（颅内和颈部）成像和超声心动图。3-5然而，这些建议是基于适度和不同程度的证据和专家意见。许多推荐的中风诊断测试缺乏正式的技术评估。
Diagnostic tests are a routine part of clinical care, accounting for a considerable amount of clinical effort and costs. We commonly assess the quality of medical care by examining these processes of care rather than their outcomes. However, the evidence base for “good” medical care, even guideline-recommended care, is often less strong than we realize. 1 This is particularly true for diagnostic tests that only influence outcomes indirectly by changing decision making and management. 2 Thus, in routine clinical practice, fundamental questions go unasked or unanswered: Why do we test? Who should we test?These questions, although not unasked, are largely unanswered for most diagnostic tests for stroke. Every year, millions of individuals worldwide suffer a stroke, 80%–87% of which are ischemic. Clinical practice guidelines recommend several imaging tests for suspected or confirmed stroke and transient ischemic attack (TIA) including recommendations on axial brain imaging [eg, computed tomography (CT) or magnetic resonance imaging (MRI)], vascular (intracranial and cervical) imaging, and echocardiography. 3–5 However, these recommendations are based on modest and varying levels of evidence and expert opinion. Formal technology assessments of many recommended diagnostic tests for stroke are lacking.