The impact of chest computed tomography and chest radiography on clinical management of cystic fibrosis lung disease
| Autor: | Ferenc Karpati, L.E. Jenkins, D.M. Cox, Yvonne Belessis, Carla Federica Bortoluzzi, L. Da Dalt, Baroukh M. Assael, Ciro D'Orazio, Stéphanie Bui, V. Švabe, J.C. Dubus, L. Honková, A. Jung, Tanja Pressler, M. Geerdink, Phil Robinson, C. Vazquez, Rosaria Casciaro, Valeria Raia, A.J.M. Reid, C. Mainguy, Daan Caudri, Antonella Tosco, S. Rovira, M.C. Cavicchi, Eleonora Pontello, O. Sepe, Stephen M. Stick, A. Tai, Silvia Gartner, Paolo Rossi, M. G. Myriam Hunink, Veronika Skalická, Harm A.W.M. Tiddens, C.R. Hansen, A. Möller, Emily Pintani, Karin M. de Winter-de Groot, A.S. Neri, E. Rietschel, André Schultz, F. De Gregorio, Marijke Proesmans, F. Bremont, Paul Robinson |
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| Přispěvatelé: | Epidemiology, Radiology & Nuclear Medicine, Pediatrics |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
Pulmonary and Respiratory Medicine Male medicine.medical_specialty Cystic Fibrosis Radiography Clinical Decision-Making Computed tomography Cystic fibrosis Bronchoscopies 03 medical and health sciences 0302 clinical medicine McNemar's test Bronchoscopy medicine Humans Practice Patterns Physicians' Child Lung Cross-Over Studies medicine.diagnostic_test business.industry Standard of Care medicine.disease Patient Care Management Hospitalization 030104 developmental biology 030228 respiratory system Radiological weapon Relative risk Pediatrics Perinatology and Child Health Female Radiography Thoracic Radiology business Tomography X-Ray Computed |
| Zdroj: | Journal of Cystic Fibrosis, 19(4), 641-646. Elsevier |
| ISSN: | 1569-1993 |
| DOI: | 10.1016/j.jcf.2019.08.005 |
| Popis: | Background Recent standards of care mention chest radiography (CR) but not chest computed tomography (CT) in routine annual follow-up of children with cystic fibrosis (CF). To minimise radiation risk, CT or CR should only be performed if they impact clinical decision making. We investigated whether in addition to a wide range of commonly used clinical parameters, chest CT and/or CR in routine follow-up of CF patients influence clinical decisions. Methods 36 web based clinical vignettes (i.e. case simulations) were designed using clinical data from patients aged 8–18 years, randomly selected from two CF centres in The Netherlands. In a randomized cross-over design, clinicians assessed eight vignettes and suggested therapeutic/diagnostic management on two occasions, with a ten-week interval. Radiological information (CT or CR) was included at only one of the two assessments, in random order. Any differences in management could be attributed to information from CT or CR, and were compared by McNemar analysis. Results 44 European and Australian clinicians completed a total of 143 CT vignette pairs and 167 CR vignette pairs. CT was associated with a significant increase in antifungal treatment (Risk Ratio (RR) 2.8 (1.3–6.0, p = .02)), bronchoscopies (RR 1.6 (1.1–2.5, p = .04)), mycobacterial cultures (RR 1.3 (1.0–1.5, p = .02)), and ‘need for hospitalization’ (i.e. intravenous antibiotics and/or bronchoscopy) (RR 1.4 (1.0–1.9, p = .03)). CR led to a significant increase in inhaled antibiotics only (RR 1.3 (1.0–1.6, p = .04)). Conclusions CT but not CR, at routine biennial follow-up was associated with several changes in treatment and/or diagnostic testing, including the need for hospitalization. |
| Databáze: | OpenAIRE |
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