The purpose of this study was to evaluate the cost-effectiveness of dynamic chest CT, compared with plain chest radiography and immediate angiography, in deciding when angiography should be performed in hemodynamically stable patients with suspected aortic rupture after blunt chest trauma.
The use of CT was evaluated in relation to the prior probability of aortic rupture.
A cost-effectiveness analysis comparing six diagnostic strategies combining chest radiography, CT, and angiography in various sequences was performed.
Effectiveness was expressed as survival to hospital discharge, and costs were those incurred to society.
Estimates for the variables in the analysis were derived from published reports.
The model was evaluated for two cohorts of patients : those undergoing and those not undergoing CT for the evaluation of other injuries.
Selecting hemodynamically stable patients after blunt chest trauma with suspected aortic rupture for angiography on the basis of CT findings is more effective than doing so based on the findings on chest radiography and is cost-effective compared with other accepted health care programs.
Immediate angiography has a high incremental cost-effectiveness ratio compared with triage by CT and is warranted only in patients not undergoing CT for the evaluation of other injuries who have a prior probability of aortic rupture of 5% or more.
Mots-clés Pascal : Traumatisme, Thorax, Complication, Rupture, Aorte, Homme, Diagnostic, Angiographie, Tomodensitométrie, Analyse coût efficacité, Analyse décision, Radiodiagnostic, Appareil circulatoire pathologie, Economie santé
Mots-clés Pascal anglais : Trauma, Thorax, Complication, Rupture, Aorta, Human, Diagnosis, Angiography, Computerized axial tomography, Cost efficiency analysis, Decision analysis, Radiodiagnosis, Cardiovascular disease, Health economy
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 95-0402140
Code Inist : 002B12B02. Création : 01/03/1996.