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理性的临床检查. 这位病人有链杆菌性喉炎吗?
M H Ebell1, M A Smith, H C Barry
1Department of Family Practice, Michigan State University, East Lansing 48824-1315, USA. mark.ebell@ht.msu.edu
JAMA
|January 9, 2001
概括
诊断链路炎喉需要的不仅仅是单个症状. 使用病史和体检结果的临床预测规则,提高了对A组β-溶血性链球菌喉炎 (链球菌喉炎) 诊断的准确性.
科学领域:
- 临床诊断 临床诊断 临床诊断
- 传染病流行病学 传染病流行病学
背景情况:
- 喉痛是经常出现的医疗投诉.
- 准确诊断A组β-溶血性链球菌喉炎 (链球菌喉炎) 对于有效的患者管理至关重要.
- 现有的审查缺乏诊断证据的系统综合.
研究的目的:
- 系统地审查诊断精度和临床检查的精确性.
- 为了确定关键的历史和体检发现,表明有链球性喉炎.
主要方法:
- 通过历史记录和体检进行了MEDLINE搜索,寻找关于诊断链球菌喉的研究.
- 包括大型的,盲目的,前性研究 (≥300名患者),使用喉培养作为参考标准.
- 两位作者独立提取数据,通过共识解决差异.
主要成果:
- 链球菌喉的关键指标包括桃体/喉排泄物和最近的暴露 (正概率比3.4-1.9).
- 没有前部部节点,桃体扩大或排泄表明没有链球菌喉 (负概率比率为0.60-0.74).
- 没有任何单一的临床发现可靠地决定肠杆菌喉的进入或退出;存在三个经过验证的临床预测规则.
结论:
- 个人病史或体检元素不足以确定链球菌喉的诊断或排除.
- 经过验证的临床预测规则可以提高诊断的准确性.
- 这些规则有助于临床医生明智地使用快速抗原测试和喉培养.
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