التفاصيل البيبلوغرافية
| العنوان: |
Does CT-based Rigidity Analysis Influence Clinical Decision-making in Simulations of Metastatic Bone Disease? |
| المؤلفون: |
Nazarian, Ara, Entezari, Vahid, Villa-Camacho, Juan, Zurakowski, David, Katz, Jeffrey, Hochman, Mary, Baldini, Elizabeth, Vartanians, Vartan, Rosen, Max, Gebhardt, Mark, Terek, Richard, Damron, Timothy, Yaszemski, Michael, Snyder, Brian, Villa-Camacho, Juan C, Katz, Jeffrey N, Baldini, Elizabeth H, Rosen, Max P, Gebhardt, Mark C, Terek, Richard M |
| المصدر: |
Clinical Orthopaedics & Related Research®; Mar2016, Vol. 474 Issue 3, p652-659, 8p |
| مصطلحات موضوعية: |
COMPUTED tomography, BONE metastasis, MEDICAL decision making, RISK factors of fractures, DIAGNOSIS, THERAPEUTICS, BONE tumors, FOCUS groups, SPONTANEOUS fractures, RESEARCH funding, RISK assessment, PILOT projects, PREDICTIVE tests |
| مستخلص: |
Background: There is a need to improve the prediction of fracture risk for patients with metastatic bone disease. CT-based rigidity analysis (CTRA) is a sensitive and specific method, yet its influence on clinical decision-making has never been quantified.Questions/purposes: What is the influence of CTRA on providers' perceived risk of fracture? (2) What is the influence of CTRA on providers' treatment recommendations in simulated clinical scenarios of metastatic bone disease of the femur? (3) Does CTRA improve interobserver agreement regarding treatment recommendations?Methods: We conducted a survey among 80 academic physicians (orthopaedic oncologists, musculoskeletal radiologists, and radiation oncologists) using simulated vignettes of femoral lesions presented as three separate scenarios: (1) no CTRA input (baseline); (2) CTRA input suggesting increased risk of fracture (CTRA+); and (3) CTRA input suggesting decreased risk of fracture (CTRA-). Participants were asked to rate the patient's risk of fracture on a scale of 0% to 100% and to provide a treatment recommendation. Overall response rate was 62.5% (50 of 80).Results: When CTRA suggested an increased risk of fracture, physicians perceived the fracture risk to be slightly greater (37% ± 3% versus 42% ± 3%, p < 0.001; mean difference [95% confidence interval {CI}] = 5% [4.7%-5.2%]) and were more prone to recommend surgical stabilization (46% ± 9% versus 54% ± 9%, p < 0.001; mean difference [95% CI] = 9% [7.9-10.1]). When CTRA suggested a decreased risk of fracture, physicians perceived the risk to be slightly decreased (37% ± 25% versus 35% ± 25%, p = 0.04; mean difference [95% CI] = 2% [2.74%-2.26%]) and were less prone to recommend surgical stabilization (46% ± 9% versus 42% ± 9%, p < 0.03; mean difference [95% CI] = 4% [3.9-5.1]). The effect size of the influence of CTRA on physicians' perception of fracture risk and treatment planning varied with lesion severity and specialty of the responders. CTRA did not increase interobserver agreement regarding treatment recommendations when compared with the baseline scenario (κ = 0.41 versus κ = 0.43, respectively).Conclusions: Based on this survey study, CTRA had a small influence on perceived fracture risk and treatment recommendations and did not increase interobserver agreement. Further work is required to properly introduce this technique to physicians involved in the care of patients with metastatic lesions. Given the number of preclinical and clinical studies outlining the efficacy of this technique, better education through presentations at seminars/webinars and symposia will be the first step. This should be followed by clinical trials to establish CTRA-based clinical guidelines based on evidence-based medicine. Increased exposure of clinicians to CTRA, including its underlying methodology to study bone structural characteristics, may establish CTRA as a uniform guideline to assess fracture risk.Level Of Evidence: Level III, economic and decision analyses. [ABSTRACT FROM AUTHOR] |
|
Copyright of Clinical Orthopaedics & Related Research® is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) |
| قاعدة البيانات: |
Complementary Index |
Full Text Finder