及时报告术前 CT 扫描是否会影响急诊开腹手术患者的预后?

IF 1.1 4区 医学 Q3 SURGERY Annals of the Royal College of Surgeons of England Pub Date : 2024-06-13 DOI:10.1308/rcsann.2023.0040
S Ikram, N Mirtorabi, D Ali, H Aain, D N Naumann, M Dilworth
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引用次数: 0

摘要

简介及时进行术前计算机断层扫描(CT)对于需要紧急开腹手术的患者非常重要。英国指南规定,"危重 "患者(将改变当时的治疗方案)应在 1 小时内报告 CT 扫描结果,"紧急 "患者(将改变治疗方案,但不一定是当天)应在 12 小时内报告 CT 扫描结果:一项观察性研究纳入了2014年至2021年在一家国民健康服务托管机构加入国家急诊腹腔手术审计(NELA)的患者。研究调查了遵守时间指南与死亡率之间的关系。根据年龄、性别、夜间入院时间、美国麻醉学会(ASA)评分、NELA 死亡率风险和扫描类别,采用多变量逻辑回归确定遵守指南的几率比。进一步的模型确定了遵守指南对死亡率的影响,并对这些变量进行了调整:共有 1,299 名患者接受了 CT 扫描(48% 为 "危重",52% 为 "紧急")。只有 360/1,299 次(28%)扫描遵循了时间安排指南。危重扫描遵守指南的可能性较低。尽管单变量分析表明,遵守指南与降低死亡率有关,但在多变量模型中情况并非如此:只有年龄、ASA和NELA死亡风险与死亡率有显著关系:结论:少数患者符合推荐的术前 CT 报告时间,而对于被指定为 "关键 "的扫描,这种情况更少。根据主要风险变量进行调整后,这似乎并不影响死亡率。这说明指南的遵守情况似乎会影响患者的预后,这是选择偏差而非因果关系的产物。
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Does timely reporting of preoperative CT scans influence outcomes for patients following emergency laparotomy?

Introduction: Timely preoperative computed tomography (CT) scans are important for patients requiring emergency laparotomy. United Kingdom guidelines state that a CT scan should be reported within 1h for 'critical' patients (will alter management at the time) and within 12h for 'urgent' patients (will alter management but not necessarily that day).

Methods: An observational study included patients who were added to the National Emergency Laparotomy Audit (NELA) at a National Health Service trust from 2014 to 2021. The association of compliance with timings guidance and mortality was investigated. Multivariable logistic regression was used to determine the odds ratio of adherence to guidelines according to age, gender, night time admission, American Society of Anesthesiology (ASA) score, NELA mortality risk and category of scan. Further models determined the influence of adherence to guidelines on mortality, also adjusted for these variables.

Results: There were 1,299 patients (48% 'critical' and 52% 'urgent' CT scans). Only 360/1,299 (28%) of scans were undertaken with adherence to the timing guidelines. Critical scans were less likely to adhere to guidelines. Although univariable analysis suggested that adherence to guidelines was associated with reduced mortality, this was not the case in the multivariable model: only age, ASA and NELA mortality risk remained significantly associated with mortality.

Conclusions: A minority of patients met the recommended preoperative CT report timings, and this was less likely for scans designated 'critical'. This did not appear to affect mortality when adjusted for key variables of risk. This illustrates the phenomenon of guideline adherence appearing to affect patient outcomes as a product of selection bias rather than causality.

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来源期刊
CiteScore
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0.00%
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期刊介绍: The Annals of The Royal College of Surgeons of England is the official scholarly research journal of the Royal College of Surgeons and is published eight times a year in January, February, March, April, May, July, September and November. The main aim of the journal is to publish high-quality, peer-reviewed papers that relate to all branches of surgery. The Annals also includes letters and comments, a regular technical section, controversial topics, CORESS feedback and book reviews. The editorial board is composed of experts from all the surgical specialties.
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