この患者さんは,胸膜流出症ですか?
Camilla L Wong1, Jayna Holroyd-Leduc, Sharon E Straus
1Division of Geriatrics, University of Toronto, and St Michael's Hospital, Toronto, Ontario, Canada.
JAMA
|January 22, 2009
まとめ
身体検査は,胸腔出血の診断に役立ちます. 打撃音の鈍さは強烈にエフュージウムを示唆し,タクティルのフレミトスの欠如はそれをより可能性が低いものにして,潜在的に不必要な胸部X線を回避します.
科学分野:
- 肺内科 肺内科 肺内科
- 診断の精度 診断の精度
- 臨床検査について
背景:
- 満腹流出は,呼吸器系の症状を有する患者の頻繁な状態です.
- Pleural effusion のためのベッドサイドの身体検査の診断的有用性は依然として不確実です.
研究 の 目的:
- プラウラ出血の可能性を評価する際に身体検査技術の正確性に関する既存の証拠を体系的に検討する.
主な方法:
- 英語での診断の精度に関する将来的な研究について,MEDLINEとEMBASEのデータベース (1950-2008) で検索した.
- 身体検査の操作と,膜流出のX線検査の確認を比較した研究も含まれていた.
- 研究の質,参加者の採用,基準基準,診断テストの精度に関する抽出したデータ.
主要な成果:
- 5つの前向きな研究 (934人の患者) が含める基準を満たした.
- 従来の打楽器に対する鈍感性は,最も高い精度を示した (正の確率比:8.7).
- タクティル・ヴォーカル・フレミトゥスの減少がないことは,内流出の可能性が低いことを示した (負の確率比:0.21).
結論:
- パーカッションへの鈍感感とタクティルのフレミタスは,胸腔出血の重要な物理的発見です.
- 鈍感な打楽器は,出血の確率を高め,確認のために胸部X線写真が必要になります.
- 感触性フレミトゥス減少の欠如は,低確率の症例では,胸部X線写真の必要性を排除する可能性があります.
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