美国利亚研究人员对疑似肾结石患者,比较CT和超声检查的差异。发现超声检查比CT检查累积辐射暴露低,而高风险并发症诊断率,严重不良事件,疼痛评分,重回急诊率以及住院治疗率方面均没有显著差异。

—2014年9月18日《新英格兰医学杂志》

中文翻译


 

【题目】超声检查与计算机断层扫描在检查疑似肾结石中的比较

【译文】

背景:对于疑似肾结石的病人,初始成像方法是应该用计算机断层扫描(CT)还是超声检查仍缺乏共识。

方法:在这项多中心、实用性、并比较有效的试验里,因疑似肾结石到急诊科就诊的18到76岁病人,被随机安排由急诊医生进行超声检查(床边超声检查),或放疗科医生进行超声检查(放射超声)或腹部CT检查,以进行初步诊断。随后的处置由医生决定,包括是否还需进行影像检查。我们比较了三组30天高危并发症的诊断率,这些并发症与漏诊或误诊肾结石,以及6个月的累积辐射暴露有关。次要结局是严重不良事件,相关的严重不良事件(由于参与本研究所致),疼痛(以11分视觉模拟评分法进行评价,评分越高表示越疼痛),重返急诊就诊率,住院率和诊断准确率。

结果:共有2759个患者被随机分组:床边超声检查组893例,放射超声组893例,CT组958例。第一个30天中高风险并发症诊断率低(0.4%),不同检查方法之间没有差异。平均6个月累积辐射暴露在超声检查组明显低于CT组(P<0.001)。床边超声检查组中12.4%患者发生严重不良事件,放射超声组是10.8%,CT组是11.2%(P=0.50)。相关的不良事件少见(发生率是0.4%),并且各组发生情况相似。到第7天,每组的平均疼痛评分为2.0(P=0.84)。重返急诊就诊率,住院率,和诊断准确率在各组之间没有显著差异。

结论:与最初的CT检查比较,最初的超声检查与低累积辐射暴露有关。高风险并发症诊断率,严重不良事件,疼痛评分,重返急诊率以及住院治疗率没有显著差异。

 

英文原稿


 

[Title] Ultrasonography versus Computed Tomography for Suspected Nephrolithiasis

[Authors] Rebecca SmithBindman, Chandra Aubin, John Bailitz, Rimon N. Bengiamin, Carlos A. Camargo,

P.H.,Jill Corbo, Anthony J. Dean, Ruth B. Goldstein, Richard T. Griffey, Gregory D. Jay, Tarina L. Kang,

Dana R. Kriesel, O. John Ma , Michael Mallin, William Manson, Joy Melnikow, Diana L. Miglioretti,

Sara K. Miller, Lisa D. Mills, James R. Miner, Michelle Moghadassi, Vicki E. Noble, Gregory M. Press,

Marshall L. Stoller, Victoria E. Valencia, Jessica Wang, Ralph C. Wang, Steven R. Cummings, M

[Abstract]

BACKGROUND: There is a lack of consensus about whether the initial imaging method for patients with
suspected nephrolithiasis should be computed tomography (CT) or ultrasonography.

METHODS: In this multicenter, pragmatic, comparative effectiveness trial, we randomly assigned
patients 18 to 76 years of age who presented to the emergency department with suspected
nephrolithiasis to undergo initial diagnostic ultrasonography performed by an emergency physician
(point-of-care ultrasonography), ultrasonography performed by a radiologist (radiology ultrasonography),
or abdominal CT. Subsequent management, including additional imaging, was at the discretion of the
physician. We compared the three groups with respect to the 30-day incidence of high-risk diagnoses
with complications that could be related to missed or delayed diagnosis and the 6-month cumulative
radiation exposure. Secondary outcomes were serious adverse events, related serious adverse events
(deemed attributable to study participation), pain (assessed on an 11-point visual-analogue scale, with
higher scores indicating more severe pain), return emergency department visits, hospitalizations, and
diagnostic accuracy.

RESULTS: A total of 2759 patients underwent randomization: 908 to point-of-care ultrasonography, 893
to radiology ultrasonography, and 958 to CT. The incidence of high-risk diagnoses with complications in
the first 30 days was low (0.4%) and did not vary according to imaging method. The mean 6-month
cumulative radiation exposure was significantly lower in the ultrasonography groups than in the CT group
(P<0.001). Serious adverse events occurred in 12.4% of the patients assigned to point-of-care
ultrasonography, 10.8% of those assigned to radiology ultrasonography, and 11.2% of those assigned to
CT (P=0.50). Related adverse events were infrequent (incidence, 0.4%) and similar across groups. By
7 days, the average pain score was 2.0 in each group (P=0.84). Return emergency department visits,
hospitalizations, and diagnostic accuracy did not differ significantly among the groups.

CONCLUSIONS: Initial ultrasonography was associated with lower cumulative radiation exposure
than initial CT, without significant differences in high-risk diagnoses with complications, serious adverse
events, pain scores, return emergency department visits, or hospitalizations.

原文地址

http://www.nejm.org/doi/full/10.1056/NEJMoa1404446?query=featured_home

 

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