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如何在昏迷患者中识别肺栓塞:一个简单的规则
Francesca Gianni1, Mattia Bonzi2, Alessandro Jachetti2
1Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UOC Pronto Soccorso, Milan, Italy; Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy.
European journal of internal medicine
|November 9, 2023
概括
一项新的临床决策规则准确地识别了昏迷患者的肺栓塞 (PE). 这种工具有助于减少不必要的诊断测试,防止过度诊断和过度治疗在急诊室.
科学领域:
- 紧急医疗 紧急医疗
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
背景情况:
- 昏迷是肺栓塞 (PE) 的潜在症状之一.
- 标准化算法的实用性来排除PE在临床急诊室 (ED) 的昏迷患者中是不清楚的,有过度诊断和过度治疗的风险.
研究的目的:
- 评估一种简单的临床决策规则,用于识别PE昏迷患者.
- 评估该规则的敏感性和临床影响,以减少诊断测试.
主要方法:
- 一项多中心观察研究开发并测试了基于历史和临床参数的规则.
- 在患有因PE而引起昏睡的患者中评估了灵敏度.
- 临床影响被评估在连续的昏迷入院到ED.
主要成果:
- 该规则根据低血压,低心率,低SPO2,胸痛,呼吸不全,长时间的床上休息,DVT症状,以前的VTE或活跃的癌症来确定患有PE的患者.
- 该规则在检测PE时显示了90.3%的灵敏度.
- 将该规则应用于217名昏迷患者,可以将进一步诊断测试的需要减少70%.
结论:
- 大多数患有PE的昏迷患者表现出暗示该病症的临床特征.
- 临床决策规则可以有效地识别需要进一步PE排除测试的患者.
- 这种方法可以尽量减少不必要的调查,从而减少过度测试和过度诊断.
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