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Acil serviste yapılan bilgisayarlı tomografi görüntüleme istemleri ne kadar etkin?

Year 2019, , 249 - 254, 30.09.2019
https://doi.org/10.16899/jcm.596718

Abstract

Amaç: Son yıllarda giderek
gelişen radyolojik görüntüleme yöntemleri tanısal süreçte önemli bir araç
haline gelmiştir. Kolay ulaşılabilir olmaları nedeniyle görüntüleme yöntemleri
acil servislerde hasta değerlendirmede anamnez ve fizik muayenenin önüne geçmiş
fakat uygun endikasyon konulmamış, gereksiz tetkik istemleri sayısında artışı
beraberinde getirmiştir. Özellikle bilgisayarlı tomografinin fazla miktarda,
endikasyon dışı istenmesi günümüzde sağlık harcamalarını giderek arttırmış, bu
da bedel-etkinlik konusunu gündeme getirmiştir. Çalışmamızda amaç acil serviste
bilgisayarlı tomografi istemi yapılan hastaların istem gerekçelerini ve saptanan
mevcut patolojileri değerlendirerek, tetkiklerin uygunluğunu saptamaktır.

Gereç
ve Yöntem: Çalışmaya Yüksek İhtisas Eğitim ve Araştırma Hastanesi Acil
servisine altı aylık sürede başvuran ve tanısal test olarak Bilgisayarlı
tomografi görüntüleme istenen 1700 hasta dahil edildi. Bu hastaların kayıtları
hastane otomasyonu ve hasta dosyaları kullanılarak retrospektif olarak incelendi.
Çalışmaya dahil edilen hastaların yaş grupları, cinsiyeti, travma öyküsü, ön tanıları
kaydedildi. Görüntüleme ile saptanan patolojiler kaydedilerek istem
gerekçesindeki ön tanılar ile karşılaştırıldı.

Bulgular:
Çalışmaya dahil edilen hastaların tanı gruplarına göre sınıflandırılmasında;
travma nedeniyle görüntülemeye başvurulan hastaların oranı  %42.9 olarak saptanırken travma nedeniyle
maksillofasial BT çekilen olguların %81’ inde omurga BT çekilen olguların %91’ inde
patoloji saptandı. Çocukluk yaş döneminde travma nedeniyle yapılan kranial
görüntülemelerin %98.5’ inde ise patoloji saptanmadı. Cinsiyete göre
abdominopelvik BT sonuçları incelendiğinde erkeklerin %68.6’ sının kadınların
ise %63.9’unun acil patoloji saptanmadığı görüldü.







Sonuç: Görüntüleme
sonuçları incelendiğinde normal görüntüleme sayısı oldukça yüksekti. Hastalarda
tomografi istem gerekçeleri iyi irdelenmeli ve klinik karar verme kılavuzları
eşliğinde doğru endikasyonlar ile görüntüleme yapılmalıdır. Bu sayede mevcut
yüksek çekim oranları, maliyet ve hastaların radyasyon maruziyeti
azaltılabilir.

References

  • 1. Hendee WR, Becker GJ, Borgstede JP, Bosma J, Casarella WJ, Erickson BA, et al. Addressing overutilization in medical imaging. Radiology. 2010;257(1):240-5.
  • 2. Carnevale TJ, Meng D, Wang JJ, Littlewood M. Impact of an emergency medicine decision support and risk education system on computed tomography and magnetic resonance imaging use. J Emerg Med. 2015;48(1):53-7. 4.
  • 3. Griffey RT, Jeffe DB, Bailey T. Emergency physicians' attitudes and preferences regarding computed tomography, radiation exposure, and imaging decision support. Acad Emerg Med. 2014;21(7):768-77.
  • 4. Erkoç MF, İmamoğlu H, Dostbil AB, Okur. A Is cranial CT really required in the emergency department for each patient with headache? Ortadoğu Tıp Dergisi.2012,4(3):114-116
  • 5. Freid VM, Bernstein AB. Health care utilization among adults aged 55-64 years: how has it changed over the past 10 years? NCHS data brief. 2010(32):1-8.
  • 6. Dağlar B, Delİalİoğlu ÖM, Ceyhan E ve ark. Acil ortopedi ve travmatoloji polikliniğinde omurga ve pelvis değerlendirmesi için gereksiz bilgisayarlı tomografi kullanımı Acta Orthop Traumatol Turc 2008;42(1):59-63
  • 7. Köse A, Köse B, Öncü MR, Tuğrul F. Bir devlet hastanesi acil servisine başvuran hastaların profili ve başvurunun uygunluğu Gaziantep Tıp Derg 2011;17(2): 57-62
  • 8. Aydın T, Akköse Aydın Ş, Köksal Ö, Özdemir F, Kulaç S, Bulut M. Uludağ Üniversitesi Tıp Fakültesi Hastanesi Acil Servisine Başvuran Hastaların Özelliklerinin ve Acil Servis Çalışmalarının Değerlendirilmesi JAEM 2010: 163-8.
  • 9. Jennett B,Epidemiology of head injury. J Neurol Neurosurg Psychiatry. 1996 Apr; 60(4): 362–369
  • 10. Cifu DX, Kreutzer JS, Kolakowsky-Hayner SA, et al. The relationship between therapy intensity and rehabilitative outcomes after traumatic brain injury: a multicenter analysis. Arch phys Med Rehabil. 2003; 84: 1441-1448 . 11. Eker C, Schalen W, Asgeirsson B, Grande PO, et al. Reduced mortality after severe head injury will increase the demands for rehabilitation services. Brain Injury 2000; 14: 605-619.
  • 12. Hukkelhoven CW, Steyerberg EW, Rampen AJJ, et al Patient age and outcome following severe traumatic brain injury: an analysis of 5600 patients. J Neurosurg 2003; 99:666-673.
  • 13. Stiell IG, Wells GA, Vandemheen K, Laupacis A, Brison R, Eisenhover MA, Variation in ED use of computed tomography for patients with minor head injury.Ann Emerg Med 1997; 30: 14-22
  • 14. Thomson R, Gray J, Madhok R, Mordue A, Mendelow AD.Effect of guidelines on management of head injury on record keeping and decision making in accident and emergency departments.Qual Health Care. 1994 Jun;3(2):86-91.
  • 15. Ingebrigsten T, Romner B. Routine early CT-scan is cost saving after minor head injury. Acta Neurol Scand 1996; 93: 207-210
  • 16. Ibanez J, Arıkan F, Pedraza S, Sanchez E, Poca MA, Rodriguez D. Reliability of clinical guidelines in the detection of patients at risk following mild head injury:results of aprospective study. J Neurosurg 2004; 100: 825-83
  • 17. Haydel M.J, Preston C.A, Mills TJ, Luber S, Blaudeau BAE, Deblieux P.M.C.Indications For Computed Tomography in Patients With Minor Head İnjury. N Engl J Med, 2000;343:100-105
  • 18. Masson F, Thicoipe M, Mokni T, et al. Epidemiology of traumatic comas: a prospective population-based study. Brain Injury. 2003; 17: 279-293.
  • 19. Hodgson L: Cost Containment in the Emergency Department. CAL/ACEP 1993 Source Guide, 1993:710
  • 20. Ergene Ü, Ergene O, Fowler J. Acil Tıptaki Tanı Testlerinde Bedel-Etkinlik, Süleyman Demirel Üniversitesi Yayınları, Yayın No:3, Mayıs 1999, İzmir.

How effective are the computerized tomography imaging prompts in the emergency department?”

Year 2019, , 249 - 254, 30.09.2019
https://doi.org/10.16899/jcm.596718

Abstract

Aim: In
recent years, radiological imaging methods have become an important tool in the
diagnostic process. Because of their easy accesible feature, imaging modalities
has passed anamnesis and physical axamination in patient evaluation in
emergency departments, however, there was no appropriate indication and an
increase in the number of unnecessary investigations present.
In particular, the demand for out-of-indications for
computed tomography has increased health spending, which has raised the issue
of cost-effectiveness.
The aim of our
study was to evaluate the reasons for request of computed tomography in the
emergency department and to determine the suitability of the investigations by
evaluating the existing pathologies.

Materials and Methods: A total of 1700 patients who
were admitted to the emergency department of the Yuksek IhtisasTraining and
Research Hospital during a six-month period and who were requested to perform a
computed tomography imaging as a diagnostic test were included in the study.

The records of these patients were retrospectively
examined using hospital automation and patient files. Age groups, gender,
history of trauma and preliminary diagnoses of the patients  were recorded.
The detected pathologies by imaging were recorded and compared with the
preliminary diagnoses.

Results: In
the classification of patients included in the study according to diagnostic
groups; 42.9% (n: 661) of the patients  were referred for imaging due to trauma. 81%
of patients who underwent maxillofacial CT and 91% of patients with spinal CT for
trauma, emergent patolojies were detected.
98.5%
of the cranial imaging performed for trauma during childhood did not reveal any
pathology.
According to abdominopelvic CT
results  in men 68.6%  and in women 63.9% there was positive result.







Conclusion: Acoording to the imaging results,  the number of normal imaging was really high.. In patients, the
rationale for tomography should be examined well and imaging should be
performed with the right indications accompanied by clinical decision making
guidelines.
In this way, current high shots, cost and radiation exposure of patients
can be reduced.

References

  • 1. Hendee WR, Becker GJ, Borgstede JP, Bosma J, Casarella WJ, Erickson BA, et al. Addressing overutilization in medical imaging. Radiology. 2010;257(1):240-5.
  • 2. Carnevale TJ, Meng D, Wang JJ, Littlewood M. Impact of an emergency medicine decision support and risk education system on computed tomography and magnetic resonance imaging use. J Emerg Med. 2015;48(1):53-7. 4.
  • 3. Griffey RT, Jeffe DB, Bailey T. Emergency physicians' attitudes and preferences regarding computed tomography, radiation exposure, and imaging decision support. Acad Emerg Med. 2014;21(7):768-77.
  • 4. Erkoç MF, İmamoğlu H, Dostbil AB, Okur. A Is cranial CT really required in the emergency department for each patient with headache? Ortadoğu Tıp Dergisi.2012,4(3):114-116
  • 5. Freid VM, Bernstein AB. Health care utilization among adults aged 55-64 years: how has it changed over the past 10 years? NCHS data brief. 2010(32):1-8.
  • 6. Dağlar B, Delİalİoğlu ÖM, Ceyhan E ve ark. Acil ortopedi ve travmatoloji polikliniğinde omurga ve pelvis değerlendirmesi için gereksiz bilgisayarlı tomografi kullanımı Acta Orthop Traumatol Turc 2008;42(1):59-63
  • 7. Köse A, Köse B, Öncü MR, Tuğrul F. Bir devlet hastanesi acil servisine başvuran hastaların profili ve başvurunun uygunluğu Gaziantep Tıp Derg 2011;17(2): 57-62
  • 8. Aydın T, Akköse Aydın Ş, Köksal Ö, Özdemir F, Kulaç S, Bulut M. Uludağ Üniversitesi Tıp Fakültesi Hastanesi Acil Servisine Başvuran Hastaların Özelliklerinin ve Acil Servis Çalışmalarının Değerlendirilmesi JAEM 2010: 163-8.
  • 9. Jennett B,Epidemiology of head injury. J Neurol Neurosurg Psychiatry. 1996 Apr; 60(4): 362–369
  • 10. Cifu DX, Kreutzer JS, Kolakowsky-Hayner SA, et al. The relationship between therapy intensity and rehabilitative outcomes after traumatic brain injury: a multicenter analysis. Arch phys Med Rehabil. 2003; 84: 1441-1448 . 11. Eker C, Schalen W, Asgeirsson B, Grande PO, et al. Reduced mortality after severe head injury will increase the demands for rehabilitation services. Brain Injury 2000; 14: 605-619.
  • 12. Hukkelhoven CW, Steyerberg EW, Rampen AJJ, et al Patient age and outcome following severe traumatic brain injury: an analysis of 5600 patients. J Neurosurg 2003; 99:666-673.
  • 13. Stiell IG, Wells GA, Vandemheen K, Laupacis A, Brison R, Eisenhover MA, Variation in ED use of computed tomography for patients with minor head injury.Ann Emerg Med 1997; 30: 14-22
  • 14. Thomson R, Gray J, Madhok R, Mordue A, Mendelow AD.Effect of guidelines on management of head injury on record keeping and decision making in accident and emergency departments.Qual Health Care. 1994 Jun;3(2):86-91.
  • 15. Ingebrigsten T, Romner B. Routine early CT-scan is cost saving after minor head injury. Acta Neurol Scand 1996; 93: 207-210
  • 16. Ibanez J, Arıkan F, Pedraza S, Sanchez E, Poca MA, Rodriguez D. Reliability of clinical guidelines in the detection of patients at risk following mild head injury:results of aprospective study. J Neurosurg 2004; 100: 825-83
  • 17. Haydel M.J, Preston C.A, Mills TJ, Luber S, Blaudeau BAE, Deblieux P.M.C.Indications For Computed Tomography in Patients With Minor Head İnjury. N Engl J Med, 2000;343:100-105
  • 18. Masson F, Thicoipe M, Mokni T, et al. Epidemiology of traumatic comas: a prospective population-based study. Brain Injury. 2003; 17: 279-293.
  • 19. Hodgson L: Cost Containment in the Emergency Department. CAL/ACEP 1993 Source Guide, 1993:710
  • 20. Ergene Ü, Ergene O, Fowler J. Acil Tıptaki Tanı Testlerinde Bedel-Etkinlik, Süleyman Demirel Üniversitesi Yayınları, Yayın No:3, Mayıs 1999, İzmir.
There are 19 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Original Research
Authors

Özge Özkan Yıldız This is me

Suna Eraybar 0000-0003-4306-9262

Halil Kaya 0000-0003-2005-6100

Erol Armağan This is me 0000-0002-4641-9873

Publication Date September 30, 2019
Acceptance Date July 25, 2019
Published in Issue Year 2019

Cite

AMA Özkan Yıldız Ö, Eraybar S, Kaya H, Armağan E. Acil serviste yapılan bilgisayarlı tomografi görüntüleme istemleri ne kadar etkin?. J Contemp Med. September 2019;9(3):249-254. doi:10.16899/jcm.596718