臨床検査は下肢の周辺動脈疾患を予測していますか?
Nadia A Khan1, Sherali A Rahim, Sonia S Anand
1Department of Medicine, University of British Columbia, Vancouver, Canada. nakhan@shaw.ca
JAMA
|February 2, 2006
まとめ
周辺動脈疾患 (PAD) の臨床検査は有用ですが,決定的なものではありません. 手持ちのドップラーを用いたPADスクリーニングスコアは,この一般的な疾患の診断の最も高い正確性を提供します.
科学分野:
- 血管医学 血管医学とは
- 診断の精度 診断の精度
- 臨床検査について
背景:
- 周辺動脈疾患 (PAD) は,発症率と死亡率の増加に関連した一般的な状態です.
- 医師は,PADのさらなる診断検査を必要とする患者を特定するために,臨床検査に依存しています.
研究 の 目的:
- PADの診断における臨床検査の正確性と精度を体系的に検討する.
- 様々な身体検査の発見と患者の病歴の要素の診断的有用性を評価する.
主な方法:
- 身体検査によるPAD診断に関する研究のために,MEDLINEとCochraneデータベースの包括的な文献検索が行われました.
- 含まれている研究では,アンケル・ブラキアル・インデックス,デュプレックス・ソノグラフィー,またはアンジオグラフィーなどの基準基準と比較した臨床結果が含まれています.
- データ抽出と品質レビューは,2人の著者によって独立して行われました.
主要な成果:
- 無症状の患者では,骨格不全,股関節痛,脈動異常がPADの重要な指標である.
- 症状のある患者では,肌の冷え込み,ブリーツ,脈拍の異常が重要な診断結果です.
- 鳴き声や脈拍の異常がないと,PADの確率は低下します.
- 手持ちのドップラーを組み込んだPADスコアリングシステムは,優れた診断精度を実証しました.
結論:
- PADの臨床検査の結果は,プレテストの確率とともに解釈されるべきである.
- 個々の臨床的発見は,PADを決定的に診断または排除するのに不十分です.
- 手持ちのドップラーを用いたPADスクリーニングスコアは,最も高い診断精度を提供します.
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