临床决策支持系统在结核潜伏感染筛查诊断中的应用

Application of clinical decision support system in screening and diagnosis of latent tuberculosis infection

目的探索临床决策支持系统(CDSS)在某三甲综合医院对结核潜伏感染(LTBI)高危患者筛查和诊断中的效果。方法对2019年1月-2021年12月中日友好医院住院的LTBI高危患者,按照是否应用CDSS管理LTBI将患者分为CDSS应用前组和CDSS应用后组,采用倾向性评分匹配降低组间的混杂因素影响后,对比分析CDSS应用对LTBI筛查率、诊断阳性率的影响。结果CDSS应用前组中的1231例LTBI高危患者,467例接受结核菌素皮肤试验(TST)或γ-干扰素释放试验(IGRA),45.82%联合胸部影像学检查,52例诊断为LTBI者;CDSS应用后组纳入802例LTBI高危患者,481例接受TST或IGRA检测,45.32%联合胸部影像学检查,76例诊断为LTBI者。倾向性评分匹配后,LTBI筛查率由CDSS应用前的44.75%(290/648)提高至CDSS应用后的54.48%(353/648)(P=0.001);LTBI诊断阳性率由CDSS应用前的12.76%(37/290)提高至CDSS应用后的14.73%(52/353),差异无统计学意义(P=0.471)。其中,接受透析疗法、器官移植患者LTBI筛查率均有所提升(P<0.05);接受肿瘤坏死因子治疗患者、透析疗法、器官移植患者LTBI诊断阳性率略有上升(P>0.05)。结论CDSS应用有利于提高LTBI高危患者的筛查率,LTBI诊断阳性率有所上升但差异不显著。CDSS在优化LTBI规范管理方面仍有较大发展空间。

OBJECTIVE To explore the effect evaluation of screening and diagnosis of high-risk patients with latent tuberculosis infection(LTBI)based on clinical decision support system(CDSS)based in a general hospital.METHODS High-risk LTBI patients hospitalized in China-Japan Friendship Hospital from Jan.2019 to Dec.2021 were divided into the pre-CDSS application group and post-CDSS application group according to whether CDSS was used to manage LTBI.After the influence of confounding factors between the groups was reduced by propensity score matching,the effects of CDSS application on the screening rate and diagnostic positive rate of LTBI were compared and analyzed.RESULTS Among the 1231 high-risk patients with LTBI in the pre-CDSS application group,467 patients received tuberculin skin tes(TST)or interferon-gamma release test(IGRA)detection,45.82%of the patients were combined with chest imaging examination,and 52 patients were diagnosed with LTBI.In the post-CDSS application group,802 patients with high risk of LTBI were included,481 patients underwent TST or IGRA test,45.32%of the patients were combined with chest imaging examination,and 76 patients were diagnosed with LTBI.After propensity score matching,the LTBI screening rate increased from 44.75%(290/648)before CDSS application to 54.48%(353/648)after CDSS application(P=0.001).The positive rate of LTBI diagnosis increased from 12.76%(37/290)before CDSS application to 14.73%(52/353)after CDSS application,and the difference was not statistically significant(P=0.471).Among them,the LTBI screening rates in patients receiving dialysis therapy and organ transplantation were improved(P<0.05).The positive rate of LTBI diagnosis in patients undergoing tumor necrosis factor,dialysis therapy and organ transplantation was slightly increased(P>0.05).CONCLUSION The CDSS application was beneficial to improve the screening rate of patients at high risk of LTBI,and the positive rate of LTBI diagnosis were increased but the difference was not significant.There were large room for the development of CDSS in optimizing LTBI specification management.