理性的临床检查. 这个病人有主动脉反吗?
1Department of Medicine, University of Toronto and the University Health Network, Ontario, Canada.
JAMA
|June 22, 1999
概括
通过心脏病学家的临床检查,可以准确地检测出主动脉反 (AR). 早期扩张性的存在是诊断的关键,而它的缺席有助于排除AR. 对于不那么专业的临床医生,需要进一步的研究.
科学领域:
- 心脏病学 心脏病学
- 诊断的准确性 诊断的准确性
- 临床检查 临床检查
背景情况:
- 大动脉反 (AR) 是一种显著的膜心脏病.
- 准确的AR诊断对于及时干预至关重要.
- 临床检查在AR诊断中的作用需要彻底评估.
研究的目的:
- 系统地审查有关诊断大动脉反的临床检查方法的精度和准确性的现有证据.
- 确定最可靠的临床标志来检测和排除AR.
主要方法:
- 针对1966年1月至1997年7月期间发表的英语文章进行了全面的MEDLINE搜索.
- 审查了相关文章的参考清单,并与作者联系以获取更多信息.
- 两位作者独立评估了16项研究的方法质量.
主要成果:
- 心脏病学家通过录音带 (kappa = 0.51) 检测透气的准确度中等,在临床环境中达成良好一致 (94%).
- 早期透析的存在是AR的强有力的指标 (积极概率比 (LR) 8.8-32.0).
- 缺少早期的扩张性声对于排除AR (负LR 0.2-0.3) 是有价值的,尽管其他迹象显示敏感性和特异性较差.
结论:
- 经验丰富的心脏病学家进行的临床检查对于诊断大动脉吐是准确的.
- 经验较少的临床医生对临床检查的诊断效用需要进一步调查.
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