To evaluate the influences of patient preference and treatment costs on the diagnostic approach to blunt aortic trauma.
Decision and cost-utility analysis.
A MEDLINE search of all literature dealing with the diagnosis and management of blunt aortic injury was used to establish assumptions and assign baseline probability estimates.
Utility assignments were made from published data and our own assignments.
Study Selection :
Only randomized, prospective trials that used aortography as the gold standard test were used to assign baseline accuracy of transesophageal echocardiography and dynamic chest computed tomography.
Other baseline estimates were taken from class II and class III published data.
A decision tree compared 4 diagnostic approaches for blunt chest trauma after an initial normal chest radiograph : observation with follow-up chest radiography, aortography, transesophageal echocardiography, and dynamic chest computed tomography.
Utility (a quality-of-life measure) was assigned to ultimate health states to incorporate patient preference.
Chest radiography and aortography had similar utility.
Aortography gained 1 quality-adjusted life year for minimal cost.
Transesophageal echocardiography and dynamic chest computed tomography lose quality-adjusted life-years at increased cost. (...)
Mots-clés Pascal : Traumatisme, Aorte, Diagnostic, Aortographie, Indication, Exploration ultrason, Tomodensitométrie, Analyse avantage coût, Homme, Appareil circulatoire pathologie, Vaisseau sanguin pathologie, Aorte pathologie, Radiodiagnostic
Mots-clés Pascal anglais : Trauma, Aorta, Diagnosis, Aortography, Indication, Sonography, Computerized axial tomography, Cost benefit analysis, Human, Cardiovascular disease, Vascular disease, Aortic disease, Radiodiagnosis
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 96-0321375
Code Inist : 002B16A. Création : 10/04/1997.