合理的な臨床検査について. この患者さんは, clubbing をしていますか?
1Queen's University, Hotel Dieu Hospital, 166 Brock St, Kingston, Ontario, Canada K7L 5G2. myersk@hdh.kari.net
JAMA
|July 24, 2001
まとめ
様々な病気の兆候であるデジタル・クラブリングは,特定の測定を用いて特定することができます. プロフィール角度とファランゲル深さの比率は,正確な臨床評価のための推奨される定量指標です.
科学分野:
- 医療診断 医療診断
- 臨床検査について
- 肺内科 肺内科 肺内科
背景:
- デジタル・クラブは,古代から多くの病気と関連づけられてきた.
- 先進的な clubbing は認識できるが,初期の clubbing はしばしば診断上の課題を提示する.
研究 の 目的:
- デジタルクラブの臨床検査の精度と正確性に関する文献を体系的にレビューする.
- クルビングを診断するための信頼できる定量指標を特定する.
主な方法:
- 1966年から1999年にかけてのMEDLINEと文献の体系的な文献レビューを実施しました.
- 患者でのクラブの定量または質的評価を含む16件の研究が含まれています.
- 定量指数,検査精度,疾患関連精度に関する抽出データ.
主要な成果:
- プロフィールアングル (>176°),ヒポニヒアルアングル (>192°),ファランゲアル深度比 (>1.0) は,クラブの定量指標として使用されます.
- クルビングのベッドサイド評価に関する観察者間の合意は変動する (kappa 0.390.90).
- クラブは肺がん (LR 3.9) と炎症性腸疾患 (LR 2.83.7) のマーカーである.
結論:
- デジタルクラブを特定するためにプロフィール角度とファランゲル深さの比率を使用することを推奨します.
- インデックスはそれぞれ180°と1.0を超えると,さらなる調査のための臨床的判断を強調します.
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