Computed tomography referral guidelines adherence in Europe: insights from a seven-country audit.

Autor: Singer C; The Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel., Saban M; The Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel.; Nursing Department, School of Health Sciences, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel., Luxenburg O; Medical Technology, Health Information and Research Directorate, Ministry of Health, Jerusalem, Israel., Yellin LB; The Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel., Hierath M; European Society of Radiology, Vienna, Austria., Sosna J; Department of Radiology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel. jacobs@hadassah.org.il., Karoussou-Schreiner A; Radiation Protection Department, Health Directorate, Ministry of Health, Luxembourg City, Luxembourg., Brkljačić B; Department of Radiology, University Hospital Dubrava, School of Medicine, University of Zagreb, Zagreb, Croatia.
Jazyk: angličtina
Zdroj: European radiology [Eur Radiol] 2024 Oct 10. Date of Electronic Publication: 2024 Oct 10.
DOI: 10.1007/s00330-024-11083-x
Abstrakt: Background: Ensuring appropriate computed tomography (CT) utilization optimizes patient care while minimizing radiation exposure. Decision support tools show promise for standardizing appropriateness.
Objectives: In the current study, we aimed to assess CT appropriateness rates using the European Society of Radiology (ESR) iGuide criteria across seven European countries. Additional objectives were to identify factors associated with appropriateness variability and examine recommended alternative exams.
Methods: As part of the European Commission-funded EU-JUST-CT project, 6734 anonymized CT referrals were audited across 125 centers in Belgium, Denmark, Estonia, Finland, Greece, Hungary, and Slovenia. In each country, two blinded radiologists independently scored each exam's appropriateness using the ESR iGuide and noted any recommended alternatives based on presented indications. Arbitration was used in case auditors disagreed. Associations between appropriateness rate and institution type, patient's age and sex, inpatient/outpatient patient status, anatomical area, and referring physician's specialty were statistically examined within each country.
Results: The average appropriateness rate was 75%, ranging from 58% in Greece to 86% in Denmark. Higher rates were associated with public hospitals, inpatient settings, and referrals from specialists. Variability in appropriateness existed by country and anatomical area, patient age, and gender. Common alternative exam recommendations included magnetic resonance imaging, X-ray, and ultrasound.
Conclusion: This multi-country evaluation found that even when using a standardized imaging guideline, significant variations in CT appropriateness persist, ranging from 58% to 86% across the participating countries. The study provided valuable insights into real-world utilization patterns and identified opportunities to optimize practices and reduce clinical and demographic disparities in CT use.
Key Points: Question Largest multinational study (7 EU countries, 6734 CT referrals) assessed real-world CT appropriateness using ESR iGuide, enabling cross-system comparisons. Findings Significant variability in appropriateness rates across institution type, patient status, age, gender, exam area, and physician specialty, highlighted the opportunities to optimize practices based on local factors. Clinical relevance International collaboration on imaging guidelines and decision support can maximize CT benefits while optimizing radiation exposure; ongoing research is crucial for refining evidence-based guidelines globally.
(© 2024. The Author(s).)
Databáze: MEDLINE
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