这个病人有急性胆囊炎吗?
Robert L Trowbridge1, Nicole K Rutkowski, Kaveh G Shojania
1Department of Medicine, University of California, San Francisco 94143-0120 , USA.
JAMA
|December 31, 2002
概括
没有单一的症状或实验室测试可靠地诊断出急性胆囊炎. 经验丰富的临床医生使用因素和成像的组合,如超声波,以确认患有腹痛的患者的诊断.
科学领域:
- 胃肠病学 胃肠病学
- 诊断医学 诊断医学 诊断医学
- 临床决策 临床决策
背景情况:
- 诊断急性胆囊炎是资源密集的.
- 很少有患有腹痛的患者患有胆囊炎.
研究的目的:
- 评估病史,体检或实验室是否可以识别需要对急性胆囊炎进行成像的患者.
- 确定临床发现和实验室测试的诊断效用.
主要方法:
- 对急性胆囊炎病史,体检和实验室检测研究的系统文献综述 (1950-2002).
- 包括对照组的研究和明确的诊断标准.
- 数据由两位作者独立抽象.
主要成果:
- 没有任何单一的临床或实验室发现可以可靠地排除急性胆囊炎.
- 墨菲征兆和RUQ敏感性具有有限的诊断价值 (LRs包括1.0).
- 急性胆囊炎的诊断印象具有较高的LR (25-30),但导致因素尚不清楚.
结论:
- 没有单一的测试足以诊断或排除急性胆囊炎.
- 结合发现和临床医生的态度至关重要.
- 需要进一步的研究来描述更好的诊断策略的预测概率.
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