新冠肺炎疫情下综合医院发热门诊胸部影像检查的初步研究

目的分析新冠肺炎疫情下某综合医院发热门诊数字化X射线摄影(DR)及胸部CT的应用情况及变化趋势。方法采用回顾性研究。通过医院医疗大数据平台和院内影像归档和通信系统(PACS)提取2020年1月20日至3月20日及2019年同期发热门诊就诊人次和行胸部影像检查的患者影像信息,分析不同时期发热门诊行影像检查的次数、比率和肺内炎症检出率的变化情况;提取某综合医院西城院区和通州院区2个院区发热门诊自专用胸部CT安装以来行胸部CT检查的患者影像信息,分析胸部CT在肺内炎症的检出情况。计数资料采用次数和百分比(%)表示,组间比较采用χ~2检验或Fisher精确概率法。结果 2020年1月20日至3月20日,2个院区发热门诊就诊人次为5 967人次,行影像检查4 856人次,检查率为81.38%,其中肺内炎症1 502例,阳性率为30.93%;2019年同期,2个院区发热门诊就诊人次为7 416人次,行影像检查3 317人次,检查率为44.73%,其中肺内炎症1 351例,阳性率40.73%。新冠肺疫情下行影像检查的比率较2019年同期显著提高,但阳性率较2019年显著下降9.83%(χ~2=82.28,P<0.001)。疫情下行发热门诊专用胸部CT检查525人次,其中肺内有病变433例,肺内病变检出率为82.48%。在肺内炎症检出方面,CT检出肺内炎症146例,检出率为27.81%,CT提示病毒性肺炎患者5例。结论新冠肺炎疫情下发热门诊行影像检查的比率较2019年同期显著升高,说明疫情下发热门诊DR、CT影像学应用意识不断提升,医学影像学在新冠肺炎筛查中扮演越来越重要的角色。而阳性率较2019年显著下降,其主要原因在于本次新冠肺炎传染性强,为防止漏诊情况和二次感染的发生,大大提高了影像检查的比率。如何有效利用发热门诊DR、CT是现在以及未来医疗行业值得深思的问题。

Chest imaging examination in fever clinic during the epidemic period of COVID-19

Objective To analyze the application and change trend of DR and chest CT in fever clinic of a general hospital during the epidemic period of COVID-19.Methods A retrospective study was used to extract the imaging information of the number of visits and chest imaging examination in the fever clinic from January 20 to March 20,2020 and the same period in 2019 through the hospital medical big data platform and PACS system,and to analyze the changes of the times and ratio of radiation examination and the detection rate of pulmonary inflammatory lesions in different periods.The imaging information of patients who underwent chest CT examination since the installation of CT in the fever clinic of the two hospitals was extracted,and the detection of chest CT in pulmonary inflammatory lesions was analyzed.The count data were expressed as number of times or percentages,and the comparison between groups was performed using the chi-square test or Fisher exact probability.Results From January 20,2020 to March 20,2020,the number of visits to the fever clinic in the two hospitals was 5967,and radiation examination was performed in 4856,with an examination rate of 81.38%,of which 1502 cases had inflammatory changes in the lungs,with a positive rate of 30.93%.In the same period of 2019,the number of visits to the fever clinic in the two hospitals was 7416,radiological examination was performed in 3317,and the examination rate was 44.73%.Among them,there were 1351 cases of inflammatory changes in the lungs,with a positive rate of 40.73%.During the epidemic period,the rate of radiological examination of COVID-19 was significantly higher than that of the same period of 2019,but the positive rate was 9.83%lower than that of 2019(χ2=82.28,P<0.001).During the epidemic period,a total of 525 people were examined by chest CT in the fever clinic,of which 433 cases had pulmonary lesions,and the detection rate of pulmonary lesions was 82.48%.In the detection of pulmonary inflammation,CT detected pulmonary inflammation in 146 cases,with a detection rate of 27.81%of 5 patients with viral pneumonia.Conclusion During the epidemic period of COVID-19,the proportion of radiological examination in fever clinic was significantly higher than that in the same period last year,indicating that the application consciousness of DR and CT imaging in fever clinic was increasing during the epidemic period,and medical imaging played a more and more important role in pneumonia screening.The positive rate decreased significantly compared with 2019,the main reason is that COVID-19 is highly infectious,in order to prevent missed diagnosis and the occurrence of secondary infection,greatly increased the proportion of radiological examination.How to make effective use of DR and CT in fever clinic is a problem worth pondering in the medical treatment industry at present and in the future.