Acil servisten istenen MR tetkiklerinin analizi: Klinik ön tanı ve sonuç karşılaştırması ile maliyet analizi
Date
2024-05-07
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Abstract
Acil serviste difüzyon manyetik rezonans görüntüleme istenen hastalarda hastaların başvuru şikayetleri ile hastalara konulmuş olan kesin tanılarının kıyaslanarak bu radyolojik istemin gerekliliğinin tartışılması amaçlanmıştır. Bu çalışma retrospektif olarak üç aylık süreçte acil servisten difüzyon manyetik rezonans görüntüleme yapılan hastalar üzerinde yapıldı. Çalışmada hastaların başvuru zamanı (ay), yaş, cinsiyet, başvuru şikâyeti değerlendirildi. Hastalarda görüntüleme isteminin pratisyen veya uzman hekim tarafından istendiği belirlendi. Hastalarda başvuru şikâyeti ve kesin tanılara göre demografik veriler karşılaştırmalı analiz edildi. Pratisyen hekim ve acil tıp uzmanları tarafından konulan kesin tanılar karşılaştırıldı. Servis veya yoğun bakıma yatan hastaların yatış tanılarına göre karşılaştırması yapıldı. Çalışmada 530 hasta değerlendirildi. Hastaların %56,9’u kadındı. Yaş ortalaması 63,9±18,04 olup en fazla görüntüleme yapılan (%44,1) ve iskemi görülen (%47) yaş aralığı 61-80 arası oldu. Görüntüleme istemi en fazla baş ağrısı (%16,2), bölgesel uyuşma hissi (%15,1) ve bilinç bozukluğu (%12,3) olan hastalardandı. Hastaların %14,8’inde iskemi görüldü. İnme görülen hastalarda en sık hipertansiyon ve koroner arter hastalığı eşlik etmekteydi. İskemi görülen hastaların başvuru şikâyetleri en çok ekstremitede güç kaybı (%47,4) ve konuşma bozukluğu (%14) oldu. Görüntüleme istemi %78,5 oranla pratisyen hekimler tarafından yapılmıştır. Acil tıp uzmanları görüntüleme istemine göre %28,9 oranla daha fazla iskemik inme teşhisi koymuştur. Bizim çalışmamızda difüzyon manyetik rezonans görüntüleme maliyeti üç aylık dönemde 128790 ₺ (4860 $) oldu. Ayrıca patoloji izlenmeyen difüzyon manyetik rezonans görüntüleme maliyeti 110409 ₺ (%85,7) oldu. Bu çalışma sonuçlarına göre pratisyen hekimlerin mesleki tecrübesizlik ve malpraktis korkusundan dolayı hastalarda gereksiz yere difüzyon manyetik rezonans görüntüleme istediklerini düşünmekteyiz. Acil serviste difüzyon manyetik rezonans görüntüleme isteminde klinik bulgular ve literatür verileri ışığında daha seçici olunmasıyla birlikte gereksiz kullanım ve artan maliyetlerin azalacağı öngörülmektedir.
The aim of this study was to discuss the necessity of this radiologic request by comparing the presenting complaints of the patients with the final diagnosis of the patients in whom diffusion magnetic resonance imaging was requested in the emergency department. This study was retrospectively performed on patients who underwent diffusion magnetic resonance imaging in the emergency department over a three-month period. The time of presentation (month), age, gender, and complaint were evaluated. It was determined whether the imaging was ordered by a general practitioner or a specialist physician. Demographic data were analyzed comparatively according to the presenting complaint and final diagnosis. Definitive diagnoses made by general practitioners and emergency medicine specialists were compared. Patients hospitalized in the ward or intensive care unit were compared according to hospitalization diagnosis. 530 patients were evaluated in the study.56.9% of the patients were female. The mean age was 63.9±18.04 years and the age range between 61-80 years was the age range in which the most imaging was performed (44.1%) and ischemia was seen (47%).The most common reasons for imaging were headache (16.2%), regional numbness (15.1%) and impaired consciousness (12.3%).Ischemia was seen in 14.8% of patients.Hypertension and coronary artery disease were the most common comorbidities in patients with stroke.The most common presenting complaints of patients with ischemia were loss of limb strength (47.4%) and slurred speech (14%).Imaging was ordered by general practitioners with a rate of 78.5%. Emergency medicine specialists diagnosed ischemic stroke 28.9% more often than imaging consultants. In our study, the cost of diffusion magnetic resonance imaging was 128790 ₺ ($4860) in the three-month period. In addition, the cost of diffusion magnetic resonance imaging without pathology was 110409 ₺ (85.7%). According to the results of this study, we think that general practitioners unnecessarily order diffusion magnetic resonance imaging in patients due to lack of professional experience and fear of malpractice. It is predicted that by being more selective in the light of clinical findings and literature data in ordering diffusion magnetic resonance imaging in the emergency department, unnecessary use and increased costs will decrease.
The aim of this study was to discuss the necessity of this radiologic request by comparing the presenting complaints of the patients with the final diagnosis of the patients in whom diffusion magnetic resonance imaging was requested in the emergency department. This study was retrospectively performed on patients who underwent diffusion magnetic resonance imaging in the emergency department over a three-month period. The time of presentation (month), age, gender, and complaint were evaluated. It was determined whether the imaging was ordered by a general practitioner or a specialist physician. Demographic data were analyzed comparatively according to the presenting complaint and final diagnosis. Definitive diagnoses made by general practitioners and emergency medicine specialists were compared. Patients hospitalized in the ward or intensive care unit were compared according to hospitalization diagnosis. 530 patients were evaluated in the study.56.9% of the patients were female. The mean age was 63.9±18.04 years and the age range between 61-80 years was the age range in which the most imaging was performed (44.1%) and ischemia was seen (47%).The most common reasons for imaging were headache (16.2%), regional numbness (15.1%) and impaired consciousness (12.3%).Ischemia was seen in 14.8% of patients.Hypertension and coronary artery disease were the most common comorbidities in patients with stroke.The most common presenting complaints of patients with ischemia were loss of limb strength (47.4%) and slurred speech (14%).Imaging was ordered by general practitioners with a rate of 78.5%. Emergency medicine specialists diagnosed ischemic stroke 28.9% more often than imaging consultants. In our study, the cost of diffusion magnetic resonance imaging was 128790 ₺ ($4860) in the three-month period. In addition, the cost of diffusion magnetic resonance imaging without pathology was 110409 ₺ (85.7%). According to the results of this study, we think that general practitioners unnecessarily order diffusion magnetic resonance imaging in patients due to lack of professional experience and fear of malpractice. It is predicted that by being more selective in the light of clinical findings and literature data in ordering diffusion magnetic resonance imaging in the emergency department, unnecessary use and increased costs will decrease.
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Keywords
İskemik inme, Acil servis, Difüzyon ağırlıklı manyetik rezonans görüntüleme, Emergency department, Diffusion weighted magnetic resonance imaging, Ischemic stroke
Citation
Alpaslan, M ve Baykan, N. (2024). "Acil servisten istenen MR tetkiklerinin analizi: Klinik ön tanı ve sonuç karşılaştırması ile maliyet analizi". Uludağ Üniversitesi Tıp Fakültesi Dergisi, 50(1), 95-102.