Acil servisten istenen radyolojik görüntüleme incelemelerinin etkinliğinin değerlendirilmesi

Yıl 2021, Cilt: 7 Sayı: 2, 136 - 145, 30.08.2021

Ebru Arslan , İrfan Aydın , Uğur Lök , Umut Gülaçtı , Kasım Turgut , Erdal Yavuz , Cihad Sönmez

https://doi.org/10.30569/adiyamansaglik.874510

Cited By: 1

Öz

Amaç: Acil servisten istenen radyolojik görüntüleme incelemelerinin etkinliği ve görüntülemelerdeki patolojilerin değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntem: 01 Temmuz 2019 ile 01 Ağustos 2019 tarihleri arasında hastanemiz Acil Servisi’ne başvuran ve tanısal amaçlı bilgisayarlı tomografi (BT) ve manyetik rezonans görüntüleme (MRG) istenen hastaların sonuçları retrospektif olarak değerlendirildi.
Bulgular: Çalışmaya toplam 2321 BT ve difüzyon MRG görüntülemesi alınmış olup bunların 2012’si BT, 309’u difüzyon MRG görüntüleme idi. BT istemlerinin %23,9’unda, MRG’lerin %19,1’inde patoloji izlendi. En sık BT tipi kranial BT idi (n=1294, %64,3). En sık patoloji abdominopelvik BT’de (n=262,%54,9), en az patoloji omurga BT ‘de (n=11, %2,3) izlendi. BT istemlerinde, 0-10 yaş grubunda patoloji izlenme sıklığı diğer yaş gruplarından daha düşüktü (p<0,001). BT veya MRG’de patoloji izlenen hastaların yaş ortalaması patoloji izlenmeyenlerden daha yüksekti (sırasıyla p<0,001, p=0,039)
Sonuç: Acil serviste, hekimlerin ileri görüntüleme tetkiki isterken uluslararası kabul görmüş kılavuzlardan yararlanmasını öneriyoruz.

Anahtar Kelimeler

Acil servis, Bilgisayarlı Tomografi, Manyetik Rezonans Görüntüleme

Destekleyen Kurum

Herhangi bir kişi veya kurum tarafından destek alınmamıştır.

Teşekkür

yok

Evaluation of the effectiveness of radiological imaging examinations ordered from the emergency department

Öz

Aim: It was aimed to evaluate pathological findings in imaging and the effectiveness of radiological imaging examinations ordered from the emergency department.
Materials and Methods: The results of the patients who applied to the Emergency Service of our hospital between 01, July 2019 and 01, August 2019 and who requested diagnostic computerized tomography (CT) or diffusion magnetic resonance (MRG) were evaluated retrospectively.
Results: A total of 2321 radiological images were included in the study, and of these radiological images, 2012 was CT, and 309 was diffusion MRI. Pathology was observed in 23.9% of CT imaging and 19.1% of MRI. The most common type of CT was cranial CT (n=1294, 64.3%). The most frequent pathologies presence is observed in abdominopelvic CT (n=262, 54.9%), while the least presence of pathology is observed in spine CT (n=11, 2.3%). The mean age of patients with pathology in CT or MRI imaging was significantly higher than patients without pathology (p<0.001, p=0.039, respectively).
Conclusion: We recommend that physicians take advantage of the guidelines when ordering advanced imaging in Emergency Department.

Anahtar Kelimeler

Emergency department, Computed Tomography, Magnetic Resonance Imaging

Kaynakça

• Rasouli HR, Aliakbar Esfahani A, Abbasi Farajzadeh M. Challenges, consequences, and lessons for way-outs to emergencies at hospitals: a systematic review study. BMC Emerg Med. 2019;19(1):62.
• Hinson JS, Martinez DA, Cabral S, et al. Triage Performance in Emergency Medicine: A Systematic Review. Ann Emerg Med. 2019;74(1).
• Larson DB, Johnson LW, Schnell BM, Salisbury SR, Forman HP. National trends in CT use in the emergency department: 1995-2007. Radiology. 2011;258:164–173.
• Azman RR, Shah MNM, Ng KH. Radiation Safety in Emergency Medicine: Balancing the Benefits and Risks. Korean J Radiol. 2019;20(3):399–404.
• Tung M, Sharma R, Hinson JS, et al. Factors associated with imaging overuse in the emergency department: A systematic review. Am J Emerg Med. 2018;36(2):301–309.
• Ferguson B, Geralds J, Petrey J, Huecker M. Malpractice in Emergency Medicine-A Review of Risk and Mitigation Practices for the Emergency Medicine Provider. J Emerg Med. 2018;55(5):659-665.
• Korley FK, Pham JC, Kirsch TD. Use of advanced radiology during visits to US emergency departments for injury-related conditions, 1998–2007. JAMA. 2010;304(13):1465–1471.
• Wiener RS, Schwartz LM, Woloshin S. Time trends in pulmonary embolism in the United States: evidence of overdiagnosis. Arch Intern Med. 2011;171(9):831–7.
• Raja AS, Ip IK, Sodickson AD, et al. Radiology utilization in the emergency department: trends of the past 2 decades. AJR Am J Roentgenol. 2014;203(2):355-360.
• Quayle KS, Jaffe DM, Kuppermann N et al. Diagnostic testing for acute head injury in children: when are head computed tomography and skull radiographs indicated? Pediatrics. 1997;99(5, article e11).
• Kapoor WN, Karpf M, Wieand S, Peterson JR, Levey GS. A prospective evaluation and follow-up of patients with syncope. N Engl J Med. 1983;309(4):197–204.
• Simon B, Letourneau P, Vitorino E, McCall J. Pediatric minor head trauma: indications for computed tomographic scanning revisited. Journal of Trauma. 2001;51(2):231–238.
• Demir MC, Akkas M. Awareness of Risks Associated with the Use of Plain X-Ray, Computed Tomography, and Magnetic Resonance Imaging Among Emergency Physicians and Comparison with that of Other Physicians: A Survey from Turkey. Med Sci Monit. 2019;25:6587-6597. doi: 10.12659/MSM.918381.
• Oguz KK, Yousem DM, Deluca T, Herskovits EH, Beauchamp NJ. Effect of emergency department CT on neuroimaging case volume and positive scan rates. Acad Radiol. 2002;9(9):1018-1024.
• Yıldız Ö, Eraybar S, Kaya H, Armağan E. Acil serviste yapılan bilgisayarlı tomografi görüntüleme istemleri ne kadar etkin? J Contemp Med. 2019; 9(3): 249-254.
• Ozturk K, Soylu E, Bilgin C, Hakyemez B, Parlak M. Predictor variables of abnormal imaging findings of syncope in the emergency department. Int J Emerg Med. 2018;11(1):16.
• Goyal N, Donnino MW, Vachhani R, et al. The utility of head computed tomography in the emergency department evaluation of syncope. Intern Emerg Med. 2006;1(2):148–150.
• Swartzberg K, Goldstein LN. High positive computed tomography yields in the emergency department might not be a positive finding. S Afr Med J. 2018;108(3):230-234.
• Hammoud K, Lanfranchi M, Li SX, Mehan WA. What is thediagnosticvalue of head MRI afternegativehead CT in ED patientspresentingwithsymptomsatypical of stroke? Emergency radiology.2016; 23(4), 339-344.
• Stiell IG, Wells GA, Vandemheen K, et al. The Canadian CT Head Rule for patients with minor head injury. Lancet. 2001;357(9266):1391-1396.
• Kanzaria HK, Hoffman JR, Probst MA, et al. Emergency physician perceptions of medically unnecessary advanced diagnostic imaging. Acad Emerg Med.2015;22(4):390-398.