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Implantation of Total Artificial Heart in Congenital Heart Disease
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この患者さんは深静脈血栓症ですか?
Philip S Wells1, Carolyn Owen, Steve Doucette
1Department of Medicine, University of Ottawa, Ontario. pwells@ohri.ca
JAMA
|January 13, 2006
まとめ
臨床的予測ルールは,深静脈血栓症 (DVT) の診断を改善する. 可能性が低い患者では,陰性D-ダイマー検査はDVTを排除し,さらなる画像検査を避けることができます.
科学分野:
- 医療診断 医療診断
- 臨床流行病学 臨床流行病学とは
- トロンボシス研究研究
背景:
- 深静脈血栓症 (DVT) の疑いがあり,非特異的な症状があり,誤診と致死性肺栓塞のリスクが高まる外来患者.
- 選択的で効率的な診断プロセスは,この集団におけるDVTの潜在的流行を考慮して極めて重要です.
研究 の 目的:
- 臨床的予測規則を用いてD-ダイマー検査を併用または併用せずに,DVTの罹患率を評価する研究を体系的にレビューする.
- DVTの異なる臨床確率層におけるD-ダイマー検査の診断精度を評価する.
主な方法:
- 1990年から2004年にかけての英語とフランス語の研究の体系的なレビュー,DVTの疑いのある外来患者の将来的な登録を含む.
- D-ダイマー検査や画像検査の前に臨床予測のルールを適用し,最低3ヶ月間の患者フォローアップを行う.
- 臨床的確率 (低,中等,高) によって分析されたD-ダイメルのDVTの流行,感受性,特異性,および確率比 (LRs) のデータ抽象化およびプーリング.
主要な成果:
- 14件の研究 (8000人以上の患者) で,臨床予測のルールが用いられ,11件の研究で,D-ダイマー検査が組み込まれました.
- DVTの罹患率は5.0% (低い),17% (中等),および53% (高い) の確率グループで,全体的な罹患率は19%でした.
- D-ダイマー検査は,確率グループによって異なる感度と特異性を示し,負のLRは一般的に低く,特に低確率の患者 (0.18%) で示されました.
結論:
- 診断検査の前に臨床的確率を推定すると,DVTの診断の正確性が向上します.
- 低確率の患者 (DVTの罹患率 <5%) の場合,D-ダイメールの陰性結果はDVTを確実に排除し,潜在的に超音波を回避することができます.
- 高い臨床的疑いを持つ患者の場合,より低い特異性のために,D-ジメルの結果は,臨床的決定を導く唯一の指針であってはならない.
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