Study design (if review, criteria of inclusion for studies)
Randomized cross-over design
Participants
Patients aged 8-18â¯years, randomly selected from two CF centres in The Netherlands.
Interventions
36 web based clinical vignettes (i.e. case simulations) were designed using clinical data from patients. In a randomized cross-over design, clinicians assessed eight vignettes and suggested therapeutic/diagnostic management on two occasions, with a ten-week interval. Radiological information (CT or CR) was included at only one of the two assessments, in random order.
Outcome measures
Any differences in management could be attributed to information from CT or CR, and were compared by McNemar analysis.
Main results
44 European and Australian clinicians completed a total of 143 CT vignette pairs and 167 CR vignette pairs. CT was associated with a significant increase in antifungal treatment (Risk Ratio (RR) 2.8 (1.3-6.0, pâ¯=â¯.02)), bronchoscopies (RR 1.6 (1.1-2.5, pâ¯=â¯.04)), mycobacterial cultures (RR 1.3 (1.0-1.5, pâ¯=â¯.02)), and 'need for hospitalization' (i.e. intravenous antibiotics and/or bronchoscopy) (RR 1.4 (1.0-1.9, pâ¯=â¯.03)). CR led to a significant increase in inhaled antibiotics only (RR 1.3 (1.0-1.6, pâ¯=â¯.04)).
Authors' conclusions
CT but not CR, at routine biennial follow-up was associated with several changes in treatment and/or diagnostic testing, including the need for hospitalization.