Tanısal İşlemlerde Bedel-Etkinlik
Özet
Acil servisin sınırlı kaynak kullanımının yanında hızlı, yüksek duyarlılıklı tanı araçlarına ihtiyaç duyması; bedel-etkinlik değerlendirilmesini zorunlu kılar. Bedel-etkin tanı stratejilerinde klinik karar kuralları ve risk skorlarının rolü önem kazanmaktadır. Canadian CT Head Rule (Kanada Kranial BT Kuralları), National Emergency X-Radiography Utilization Study Group (NEXUS, Ulusal Acil Radyografi Kullanım Çalışma Grubu) ve HEART (History, ECG, Age, Risk Factors, Troponin) skoru gibi algoritmalar, acil serviste ileri tetkik gereksinimini belirlemede klinisyenlere rehberlik etmektedir. Öncelikle direkt grafinin kullanıldığı ve tanı konulan hastalarda hem hızlıca tedavi basamağına geçilir hem de ek tetkik ihtiyacı bulunmaz, bedel-etkin bir yol izlenmiş olur. Direkt grafinin endike olmadığı, yetersiz kaldığı veya klinik şüphenin devam ettiği hastalarda bilgisayarlı tomografi (BT) veya ultrasonografi (USG) gibi araçların kullanımı düşünülmelidir. USG safra kesesi, nefro-ürolithiazis, ektopik gebelik, apandisit değerlendirmesinde; sıvı içeriği yüksek organların değerlendirilmesinde yüksek tanısal doğruluk sunar. İyonize radyasyon içermemesi, hızlı sonuç vermesi, uygun maliyeti avantajlarından olup kullanıcı bağımlı olması dezavantajlarındandır. BT ve manyetik rezonans görüntüleme (MR), maliyeti gereği bedel-etkinlik analizinde geride kalsa da gerekli ve uygun klinik koşullarda kullanımı vazgeçilmezdir. Klinisyenin uygun sırayla ve endikasyonla hangi aracı kullanacağına karar vermesi önem arz etmektedir.
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