シリアル2点超音波とD-ダイマー対全脚のカラーコードドップラー超音波による,症状のある深静脈血栓症の疑いを診断するための連続2点超音波:ランダム化制御試験
Enrico Bernardi1, Giuseppe Camporese, Harry R Büller
1Department of Emergency and Accident Medicine, Civic Hospital, Conegliano, Italy. enrico.bernardi@ulss7.it
JAMA
|October 9, 2008
まとめ
下肢の深静脈血栓症 (DVT) の診断のための2つの超音波測定法が同等であることが判明しました. この研究では,2点超音波検査と全足超音波検査を比較し,DVTの疑いのある症状のある外科医の管理に用いられました.
科学分野:
- 血管医学 血管医学とは
- 診断用イメージング
- クリニック・トライアル 臨床試験
背景:
- 下肢における深静脈血栓症 (DVT) の診断は,通常,超音波検査を用いて行われ,2点超音波検査と全足超音波検査の2つの主要戦略があります.
- 全足の超音波検査は,小腿静脈血栓症に対してより敏感であると考えられていますが,専門的な専門知識と利用可能性が必要です.
- これらの2つのDVT診断アプローチの臨床的効果を直接比較した先のランダム化研究はありません.
研究 の 目的:
- 2点超音波検査と全足超音波検査の等価性を,下肢DVTの疑いのある外科医の管理において決定する.
- 2つの超音波戦略の診断精度と臨床結果を比較する.
主な方法:
- 展望型,多センター,ランダム化研究で,第1回疑われるDVTの症状のある外科医2098人を対象とした.
- 患者はランダムに2点超音波検査 (n=1045) または全足超音波検査 (n=1053) に割り当てられました.
- 主要評価項は,初期に超音波検査で正常な結果が出た患者の3ヶ月の症状性静脈血栓栓塞栓症の発生率であり,2007年3月まで追跡調査が行われました.
主要な成果:
- 症状のある静脈血栓塞栓症は,2ポイント戦略群の0.9% (7/801),全足戦略群の1.2% (9/763) の患者で発生した.
- 観察された発生率の差は0.3% (95%CI,-1.4%から0.8%) であり,事前に定義された同等性基準を満たした.
- 両方の診断戦略は,疑われるDVTの管理において,比較可能な安全性と有効性を示した.
結論:
- 2点超音波検査と全足超音波検査は,下肢DVTの疑いのある症状のある患者に対して,同等の診断戦略です.
- この発見は,2点超音波検査を有効な代替手段として使用することを支持し,アクセシビリティと効率性を改善する可能性がある.
- この研究は,臨床実務におけるDVT診断作業のための根拠に基づいたガイドラインを提供します.
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