Grandes variaciones en la utilización de pruebas por imagen en el diagnóstico y seguimiento de los pacientes con ictus / Variability in the use of neuroimaging techniques for diagnosis and follow-up of stroke patients

Introducción y objetivo: El radiodiagnóstico es esencial para precisar la planificación terapéutica de las personas con ictus, pero la incertidumbre sobre su efectividad puede contribuir a la variabilidad en su indicación. Este estudio tiene por objetivo describir la evolución del uso de TAC y RM en el manejo del ictus a lo largo de 5 años en la red hospitalaria del Servicio Canario de Salud y analizar la variabilidad interhospitalaria mediante el uso de datos administrativos recogidos rutinariamente. Pacientes y método: Se explotó el CMBD de los pacientes con diagnóstico de ictus o AIT (2005-2010) en 4 hospitales. Además, se incluyó la edad y el sexo del paciente, los procedimientos realizados, los diagnósticos secundarios y la estancia. Se realizó un análisis descriptivo de las características de los pacientes y un análisis bivariante mediante t de Student o Chi-cuadrado para detectar diferencias entre los pacientes según recibieran o no RM. Las desigualdades en el acceso a RM se analizaron mediante regresión logística. Resultados y conclusiones: Se incluyeron 10.487 pacientes adultos (8.571 con ictus y 1.916 con AIT). El porcentaje de pacientes con ictus que recibieron TAC aumentó desde el 89,47% en 2005 al 91,50% en 2010; en ellos, la RM aumentó desde el 25,41% en 2005 al 36,02% en 2010. Entre los pacientes con AIT el uso de TAC creció desde el 84,64 al 88,04%, y el de RM, desde el 32,53 al 39,13%. Nuestros resultados sugieren que ser mujer, joven y presentar mayor comorbilidad aumentan las probabilidades de recibir RM

Introduction and objective: Imaging diagnosis is essential for treatment planning in stroke patients. However, use of these techniques varies due to uncertainty about their effectiveness. Our purpose was to describe the use of CT and MRI in stroke and transient ischaemic attack (TIA) over 5 years in hospitals belonging to the Canary Islands Health Service and analyse interhospital variability based on routinely collected administrative data. Patients and method: We gathered the minimum basic dataset (MBDS) from patients diagnosed with stroke or TIA between 2005 and 2010 in 4hospitals. Patients' age, sex, procedures, secondary diagnoses, and duration of hospital stay were also recorded. We conducted a descriptive analysis of patient characteristics and a bivariate analysis using the t test and the chi square test to detect differences between patients assessed and not assessed with MRI. Logistic regression was used to analyse unequal access to MRI. Results and conclusions: Our study included 10,487 patients (8,571 with stroke and 1,916 with TIA). The percentage of stroke patients undergoing a CT scan increased from 89.47% in 2005 to 91.50% in 2010. In these patients, use of MRI also increased from 25.41% in 2005 to 36.02% in 2010. Among patients with TIA, use of CT increased from 84.64% to 88.04% and MRI from 32.53% to 39.13%. According to our results, female sex, younger age, and presence of comorbidities increase the likelihood of undergoing MRI

Variability in the use of neuroimaging techniques for diagnosis and follow-up of stroke patients. / Grandes variaciones en la utilización de pruebas por imagen en el diagnóstico y seguimiento de los pacientes con ictus.

INTRODUCTION AND OBJECTIVE: Imaging diagnosis is essential for treatment planning in stroke patients. However, use of these techniques varies due to uncertainty about their effectiveness. Our purpose was to describe the use of CT and MRI in stroke and transient ischaemic attack (TIA) over 5years in hospitals belonging to the Canary Islands Health Service and analyse interhospital variability based on routinely collected administrative data. PATIENTS AND METHOD: We gathered the minimum basic dataset (MBDS) from patients diagnosed with stroke or TIA between 2005 and 2010 in 4hospitals. Patients' age, sex, procedures, secondary diagnoses, and duration of hospital stay were also recorded. We conducted a descriptive analysis of patient characteristics and a bivariate analysis using the t test and the chi square test to detect differences between patients assessed and not assessed with MRI. Logistic regression was used to analyse unequal access to MRI. RESULTS AND CONCLUSIONS: Our study included 10,487 patients (8,571 with stroke and 1,916 with TIA). The percentage of stroke patients undergoing a CT scan increased from 89.47% in 2005 to 91.50% in 2010. In these patients, use of MRI also increased from 25.41% in 2005 to 36.02% in 2010. Among patients with TIA, use of CT increased from 84.64% to 88.04% and MRI from 32.53% to 39.13%. According to our results, female sex, younger age, and presence of comorbidities increase the likelihood of undergoing MRI.

Cost-Effectiveness Methods and Newborn Screening Assessment.

Nowadays, health funding decisions must be supported by sound arguments in terms of both effectiveness and economic criteria. After more than half a century of newborn screening for rare diseases, the appropriate economic evaluation framework for these interventions is still challenging. The validity of standard methods for economic evaluation heavily relies on the availability of robust evidence, but collection of such evidence is precluded by the rareness of the conditions that may benefit from screening. Furthermore, there are a series of conceptual and methodological limitations that warrant further careful consideration when assessing the cost-effectiveness of newborn screening programs. In this chapter we provide a general overview of current economic evaluation methods and the challenges for their application to newborn screening programs.