Wetzels, C.D. (2015) Waarde van thoraxfoto’s Invloed van thoraxfoto’s op de beleidsvoering bij klinische patiënten : een retrospectief onderzoek en een vignetonderzoek. thesis, Medicine.
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Abstract
beleidsvoering. 4 Abstract Background: Chest radiography is an important diagnostic method, which can be requested for many different indications and purposes. It is an extensively used diagnostic imaging technique, which accounts for 25% of the total number of diagnostic imaging procedures. A chest X-ray (CXR) has added value only when the patient management afterwards fits the CXR findings. This implies that a treatment will be continued if the predetermined diagnosis is radiologically confirmed and will be suspended if the CXR does not confirm the accuracy of that diagnosis. The purpose of this study is to determine how often chest X-rays have clinical value. In other words: do chest X-rays actually affect ongoing management. Materials and methods: This dual study, consisting of a retrospective database study and a vignette study, was conducted at the department of Internal Medicine of the Scheper Hospital in Emmen. The study included clinical patients who were subjected to CXR during a hospitalization in the period from January 2014 to June 2014. The database study provided an answer to the question of how often a CXR leads to a patient management change. The expected percentage of CXR that may lead to a change in patient management was 69% and the percentage of 50% was considered as unacceptably low. The vignette study was conducted to analyze whether the choices of specialist in theory (vignette) match the choices made previously in actual practice (database). Also the choices of the specialists were compared to each other. Results: After controlling for the exclusion criteria, this study included 90 patients with a total of 120 CXR. Patient management changed in 42 out of 120 CXR (35%) following the CXR. When practice is tested with vignettes, it appears that specialists acted in 69,3% of the cases compatible with their own practice with regard to making a CXR. When all vignettes are taken together, it can be concluded that all specialists registered to making less chest X-rays than they actually did in practice. The specialists did agree fairly, at specific cases, with regard to making a CXR (κ = 0,340, p = 0,003). Conclusion: This study revealed that the number of CXR, performed in clinical patients, that led to a change in patient management is only 35%. Moreover, with the vignettes the specialists registered to making less CXR than they actually did in practice. The study furthermore shows that the specialists, at specific cases, did not always agree with each other about whether or not to make a CXR. Despite that the CXR is considered as being an important diagnostic tool for diagnosing different diseases, like pneumonia or acute heart failure, before subjecting the patient to the CXR one should foresee the CXR influence on patient management.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultair begeleider: and Nap, Drs. R.R.H. and Lokatie: and Afdeling Interne Geneeskunde Scheper Ziekenhuis te Emmen |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:52 |
| Last Modified: | 25 Jun 2020 10:52 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1284 |
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