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合理的な臨床検査について. この患者さんは喉の炎症ですか?
M H Ebell1, M A Smith, H C Barry
1Department of Family Practice, Michigan State University, East Lansing 48824-1315, USA. mark.ebell@ht.msu.edu
JAMA
|January 9, 2001
まとめ
喉炎の診断には,単一の症状以上のものが必要です. 病歴と身体検査の結果を用いた臨床予測のルールにより,A群ベータ溶血性小菌炎 (小菌炎) の診断の正確性が向上します.
科学分野:
- クリニカル診断とは
- 感染症の疫学について
背景:
- 喉の痛みは,一般的な医療上の苦情です.
- グループAベータ溶解性小菌喉炎 (小菌喉炎) の正確な診断は,患者の効果的な管理に不可欠です.
- 既存のレビューには,診断証拠の体系的な合成が欠けている.
研究 の 目的:
- 喉炎の臨床検査の診断の精度と正確性を体系的に検討する.
- 炎の兆候となる重要な歴史と身体検査の発見を特定する.
主な方法:
- 病歴と身体検査による喉炎の診断に関する研究をMEDLINEで検索しました.
- 大規模で,盲目,前向きな研究 (≥300人の患者) を含め,喉の培養を基準基準として使用しました.
- 2人の著者が独立してデータを抽出し,合意によって不一致を解決した.
主要な成果:
- 喉炎の主要な指標は,桃体/喉の排泄物と最近の被曝 (陽性確率比3.4-1.9) を含む.
- 帯の膨張,または液の欠落は,炎の欠落を示唆する (負の確率比0.60-0.74).
- 喉炎の感染と感染を決定する単一の臨床的発見は存在しないが,臨床的に検証された予測のルールが3つ存在する.
結論:
- 個々の病歴や身体検査の要素は,喉炎の診断または排除に不十分である.
- 検証された臨床予測規則により,診断の正確性が向上します.
- これらの規則は,臨床医が迅速な抗原検査と喉の培養物を賢明に使用するのに役立ちます.
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