合理的な臨床検査について. この患者さんは大動脈の反発症ですか?
1Department of Medicine, University of Toronto and the University Health Network, Ontario, Canada.
JAMA
|June 22, 1999
まとめ
心臓病学者の臨床検査により,大動脈吐 (AR) が正確に検出されます. 早期の浸透性の存在は診断の鍵であり,その欠如はARを排除するのに役立ちます. 専門性の低い臨床医については,さらなる研究が必要である.
科学分野:
- 心臓病学 心臓病学
- 診断の精度 診断の精度
- 臨床検査について
背景:
- 大動脈反発 (AR) は重要な弁性心疾患である.
- ARの正確な診断は,タイムリーな介入に不可欠です.
- ARの診断における臨床検査の役割は,徹底的な評価を必要とします.
研究 の 目的:
- 大動脈吐の診断のための臨床検査方法の精度と正確性に関する既存の証拠を体系的に検討する.
- ARの検出と排除のための最も信頼できる臨床的徴候を特定する.
主な方法:
- 1966年1月から1997年7月にかけて発行された英語の記事について,包括的なMEDLINE検索が行われました.
- 関連する記事の参考文献リストが検討され,追加情報を得るために著者に連絡が取られました.
- 16件の研究は,両方の著者によって,方法論的品質について独立に評価されました.
主要な成果:
- 心臓病学者は,オーディオテープ (kappa = 0.51) による静脈静脈の感知に適度な精度を示し,臨床環境での良好な合意 (94%) を示しました.
- 早期のダイアストリック・マーマーの存在は,ARの強い指標である (陽性確率比 (LR) 8.8-32.0).
- 早期の浸透性の欠如は,AR (負のLR 0.2-0.3) を排除するのに価値がありますが,他の徴候は弱い感度と特異性を示しています.
結論:
- 経験豊富な心臓科医による臨床検査は,大動脈反発の診断に正確です.
- 経験の少ない臨床医による臨床検査の診断的有用性については,さらなる調査が必要である.
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