Routine Versus Selective Multidetector-Row Computed Tomography (MDCT) in Blunt Trauma Patients: Level of Agreement on the Influence of Additional Findings on Management
Routine Versus Selective Multidetector-Row Computed Tomography (MDCT) in Blunt Trauma Patients: Level of Agreement on the Influence of Additional Findings on Management
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DOI：
10.1097/ta.0b013e318189371d
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发表时间：
2009-11-01
影响因子：
--
通讯作者：
Edwards, Michael J.
中科院分区：
文献类型：
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作者：
Deunk, Jaap;Brink, Monique;Edwards, Michael J.
简介：本研究旨在确定外科医生之间和内部关于钝性创伤患者常规与选择性多排计算机断层扫描（MDCT）结果对治疗计划影响的一致性。患者：对于本研究，从定制数据库中随机选择50名患者，该数据库最初用于比较选择性使用MDCT的诊断算法与常规MDCT的脊柱算法，胸部和腹部在同一人群中。在所有50例患者中，常规MDCT发现额外的诊断相比，选择性MDCT算法。在所有患者中，创建了包含临床参数、体格检查结果和放射学结果详细信息的纸质病例。这些病例分别交给三位不同的创伤外科医生。首先，要求外科医生根据体格检查、常规X线摄影和选择性MDCT发现的诊断制定治疗计划。随后，他们被要求提供他们的治疗计划，并了解常规MDCT额外发现的损伤。3个月后重复该程序。由于常规MDCT的额外发现，外科医生之间和内部的协议被确定为患者管理的变化，因为常规MDCT结果对患者管理的影响，外科医生之间的协议是中等的（[Kappa] = 0.46），在第一个程序和实质性的第二（[Kappa] = 0.67）。外科医生的一致性范围从中度（[kappa] 0.60）到优秀（[kappa] = 0.87）。结论：所有外科医生都同意常规MDCT额外发现的创伤性损伤，经常导致治疗计划的改变。外科医生之间和内部一致认为，这些额外的发现导致了治疗计划的改变，这一点为中度至极好。
Introduction: This study was performed to determine the agreement between and within surgeons concerning the influence on treatment plan of routine versus selective multidetector-row computed tomography (MDCT) findings in blunt trauma patients.Patients: For this study, 50 patients were randomly selected from a customized database that was originally used to compare a diagnostic algorithm with a selective use of MDCT with an algorithm with routine MDCT of the spine, chest, and abdomen within the same population. In all 50 patients, routine MDCT found additional diagnoses as compared with the selective MDCT algorithm. Of all patients, paper cases were created with detailed information on clinical parameters, findings by physical examination, and radiologic findings. The cases were independently presented to three different trauma surgeons. First, the surgeons were asked for their treatment plan based upon diagnoses found by physical examination, conventional radiography, and selective MDCT alone. Subsequently they were asked for their treatment plan with knowledge of the injuries additionally found by routine MDCT. This procedure was repeated after 3 months. The agreement between and within surgeons was determined for the change of patient management because of additional findings by routine MDCT.Results: The agreement on the influence of routine MDCT findings on patient management between surgeons was moderate ([kappa] = 0.46) in the first procedure and substantial in the second ([kappa] = 0.67). The agreement within surgeons ranged from moderate ([kappa] 0.60) to excellent ([kappa] = 0.87).Conclusion: All surgeons agreed that the traumatic injuries additionally found by routine MDCT, frequently resulted in a change of treatment plan. There was a moderate-to-excellent agreement between and within surgeons that these additional findings resulted in a change of treatment plan.