质控小组对腺性膀胱炎的超声诊断质量分析及改进措施

Analysis on quality of ultrasound diagnosis for CG and improvement measures by quality control team

目的分析腺性膀胱炎的超声报告质量及漏诊误诊原因,探讨提高该病超声诊断敏感性和符合率的措施。方法选取2018年1月~2020年12月在医院病理诊断为腺性膀胱炎并进行膀胱超声检查的患者,分析其术前超声报告的检查条件、描述质量、诊断类型及检查医师工作年限等资料,问卷表调查医师对超声诊断腺性膀胱炎的认识。采用χ2检验比较不同年资医生检查条件、描述质量、诊断类型的差异。结果共收集46例资料,超声诊断敏感性67.4%,超声诊断符合率2.2%;膀胱充盈好28例(28/46),描述完整16例(16/46),结论性诊断5例(5/46),描述性诊断41例(41/46);64%医师对腺性膀胱炎认识不足,21%医师认为超声可以鉴别该病与膀胱癌,但出具报告时不宜给出具体定性以避免误诊;不同年资组医生在检查条件、描述质量、诊断类型方面差异均无统计学意义(P> 0.05)。结论科室对腺性膀胱炎诊断符合率有待提高,主要原因对该病认识不足及部分医师为避免误诊不愿出具结论性报告,质控小组应针对具体原因采取措施实施质量持续改进。

Objective To analyze the quality of ultrasound report for cystitis glandularis(CG) and causes of missed diagnosis and misdiagnosis, and explore the measures to improve the sensitivity and coincidence rate of ultrasonic diagnosis thereof. Methods Patients who were pathologically diagnosed with CG and received bladder ultrasound examination in our hospital between January2018 and December 2020 were selected. The preoperative ultrasound report’s examination condition, description quality, diagnosis types and working years of examining physicians were analyzed, and physician’s understanding about ultrasonic diagnosis of CG was investigated via questionnaire. Physicians of varied seniorities were compared in terms of their examination conditions, description quality and diagnostic type via chi-square test. Results Data of 46 cases was collected. Ultrasonic diagnosis recorded a sensitivity of67.4% and a coincidence rate of 2.2%. Among them, 28(28/46) cases described good bladder filling, 16(16/46) cases provided complete description, five(5/46) cases made conclusive diagnosis, and 41(41/46) cases made descriptive diagnosis. Those who lacked insights into CG accounted for 64%, and 21% physicians believed that the disease can be differentiated from bladder cancer via ultrasound, yet conclusive diagnosis shall not be given when issuing report to avoid misdiagnosis. Differences in examination condition, description quality and diagnosis types among physicians of different seniorities were not statistically different(all P >0.05). Conclusion The department has yet to improve the coincidence rate of CG diagnosis. Most blame rests with the insufficient perception on the disease and unwillingness of some physicians to issue conclusive report that may lead to misdiagnosis. The quality control team shall take targeted measures to continuously improve quality.