目的:本研究旨在评估EURO-2000指南所涉及的临床情景和ACR适当性标准,以将儿童转诊至MRI并评估转诊医师对这两个指南的依从性。
方法:2022年1月,在比利时一所大学儿童医院和两家普通大学医院的儿童(0-16岁)最近1000次连续MRI请求中报告了临床情景,欧洲,与EURO-2000指南和ACR适当性标准进行回顾性匹配。针对这两个指南,独立评估了临床方案的数量和MRI转诊的理由。对来自三个中心的汇集数据进行评估,然后按中心进行分析,身体面积和处方者使用McNemar检验配对比例和χ2检验非配对比例。
结果:排除不完整或缺失的MRI请求后,分析中包括了3000个请求中的2932个。总的来说,在2932种临床情景中,1229(37.99%)由EURO-2000处理,1081(36.37%)由ACR适当性标准处理(McNemar测试,p=0.12)。比较中心时,两个指南涵盖的临床方案比例在统计学上相似。但在身体区域(p<0.001)和参考医师专业(p在0.75和0.001之间)有所不同。EURO-2000指南为头部和脊柱提供了更好的覆盖范围(p<0.05),虽然ACR适当性标准为腹部提供了更广泛的覆盖范围,骨盆,和肌肉骨骼系统(p<0.0001)。对于已解决的临床方案,两个指南的处方者依从性均非常好,所有中心的MRI检查均>94%.
结论:EURO-2000指南和ACR适当性标准均未解决三分之二的儿童临床情况。头部和颈部,胸部和腹部-骨盆检查是解剖区域,在未来为所有转诊专家实施循证临床决策支持工具时,应特别注意这些区域.
This study aims to evaluate the clinical scenarios addressed by the EURO-2000
guidelines and the ACR appropriateness criteria for referring children to MRI and assessing the referring physician compliance with both guidelines.
In January 2022, clinical scenarios reported in the last 1000 consecutive MRI requests for children (0-16 years) in one university children\'s hospital and two general university hospitals in Belgium, Europe, were retrospectively matched to the EURO-2000
guidelines and ACR appropriateness criteria. The number of clinical scenarios addressed and the justification for MRI referral were independently assessed for both guidelines. Pooled data from the three centers were evaluated and then analyzed by center, body area and prescriber using McNemar\'s test for paired proportions and χ2-tests unpaired proportions.
After excluding incomplete or missing MRI requests, 2932 of 3000 requests were included in the analysis. Overall, out of 2932 clinical scenarios, 1229 (37.99%) were addressed by EURO-2000 and 1081 (36.37%) were addressed by the ACR appropriateness criteria (McNemar test, p = 0.12). The proportions of clinical scenarios covered by the two guidelines were statistically similar when comparing centers, but varied across body regions (p < 0.001) and referring physician specialty (p between 0.75 and 0.001). EURO-2000 guidelines provided better coverage for head and spine (p < 0.05), while the ACR appropriateness criteria provided broader coverage for
abdomen, pelvis, and musculoskeletal system (p < 0.0001). For addressed clinical scenarios, prescriber compliance for both
guidelines was excellent with > 94% of justified MRI examinations in all the centers.
Both the EURO-2000
guidelines and the ACR appropriateness criteria did not address two-thirds of clinical scenarios in children. Head and neck, chest and abdominal-pelvic examinations are the anatomic regions which should receive a specific attention for the future implementation of evidence-based clinical decision support tools for all referring specialists.