Identifying Unnecessary Irradiation of Patients with Suspected Renal Colic

识别疑似肾绞痛患者的不必要照射

• 批准号: 8311552
• 负责人: Christopher L Moore
• 金额: $ 49.31万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-16 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8311552
• 关键词: Identifying; Unnecessary; Irradiation; Patients; Suspected

6. Project Abstract: Identifying unnecessary irradiation of patients with suspected renal colic Up to 12% of the population has kidney stones, and 3-5% of all persons are likely to experience an episode of renal colic in their lifetime, many of whom will present to the Emergency Department (ED) for evaluation. Computed tomography (CT) scanning is now a first-line test for suspected renal colic, and is accurate in detecting stones. However CT scanning involves significant amounts of ionizing radiation, is costly, may lead to further unnecessary testing, and rarely alters management as most kidney stones pass spontaneously. CT scanning has increased dramatically in the U.S. over the last several decades, from approximately 3 million scans done in 1980 to over 60 million in 2007. In the year 2000 there were ~12 scans per 100 people, nearly doubling to ~22 per 100 people in 2005; during that time Medicare expenditures for imaging increased from $6.2 billion to $12 billion, accounting for 23% of all Medicare spending in 2005. Long term, the radiation received from a single CT scan of the abdomen/ pelvis has been estimated to cause approximately 12 deaths for every 10,000 scans performed. While other rules for imaging have been developed and implemented in the emergency setting, there is no decision rule to guide the use of appropriate imaging in suspected renal colic. We propose to derive, validate, and test the implementation of a decision rule that will allow appropriate use of CT scan in patients evaluated for suspected renal colic. The derivation set will consist of retrospectively derived data from all patients at our institution over a 4-year period who underwent a CT flank pain protocol (CT FPP) for suspected kidney stone. Classification and regression tree (CART) analysis will be utilized to derive a rule that will reliably predict the presence of kidney stone, as well as stones requiring intervention (6mm or greater), and other urgent or emergent diagnoses likely to require intervention. Once derived, this rule will be prospectively validated using point-of-care clinician performed ultrasound, plain films when appropriate, and data from the electronic medical record. In the final phase the rule will be implemented by physician training and incorporation into the computerized physician order entry (CPOE) system. The performance of the rule will be measured against CT findings and intervention during a 90-day follow-up period. Impact of the rule and cost benefit analysis will be evaluated to determine the comparative effectiveness of the derived rule. We anticipate a rule can be derived and validated, improving patient safety and reducing cost by reducing imaging that will not alter management in suspected renal colic.

6.项目摘要：识别疑似肾绞痛患者的不必要照射 高达12%的人口患有肾结石，并且所有人中的3-5%可能经历肾结石发作。 肾绞痛在他们的一生中，其中许多人将目前的急诊科（艾德）进行评估。 计算机断层扫描（CT）扫描现在是怀疑肾绞痛的一线测试，并且在诊断中是准确的。 探测石头然而，CT扫描涉及大量的电离辐射，是昂贵的，可能导致 进一步不必要的测试，很少改变管理，因为大多数肾结石通过自发。CT 在过去的几十年里，美国的扫描量急剧增加，从大约300万台 从1980年的6000万次增加到2007年的6000万次。在2000年，每100人约有12次扫描， 2005年翻了一番，每100人约22人;在此期间，医疗保险的成像支出从2005年的100人增加到2005年的100人。 62亿至120亿美元，占2005年医疗保险总支出的23%。从长远来看，辐射 据估计，从腹部/骨盆的单次CT扫描中收到的信息可导致约12例死亡 每10，000次扫描。 虽然已经制定了其他成像规则并在紧急情况下实施，但没有 决策规则，以指导在疑似肾绞痛中使用适当的成像。我们建议推导，验证， 并测试决策规则的实施，该规则将允许在接受评估的患者中适当使用CT扫描 疑似肾绞痛推导集将包括来自我们的所有患者的回顾性数据。 在一个为期4年的机构，谁经历了CT腰痛协议（CT FPP）怀疑肾结石。 分类和回归树（CART）分析将用于推导出一条规则，该规则将可靠地预测 存在肾结石，以及需要干预的结石（6 mm或更大），以及其他紧急或 可能需要干预的紧急诊断。一旦推导出来，该规则将通过以下方式进行前瞻性验证： 床旁临床医生进行了超声检查，适当时进行平片检查，并从电子医疗系统中获取数据。 记录在最后阶段，该规则将通过医生培训和纳入 计算机化医嘱输入系统（CPOE）。该规则的性能将根据CT进行衡量 在90天的随访期内进行调查结果和干预。规则的影响和成本效益分析将 评估以确定所导出的规则的相对有效性。我们预计可以推导出一条规则 并经过验证，通过减少不会改变管理的成像，提高患者安全性并降低成本 疑似肾绞痛