慢性阻塞性肺病过度诊断和过度治疗:一个元分析
Matteo Fiore1, Matteo Ricci1, Annalisa Rosso2
1Section of Hygiene and Preventive Medicine, University of Bologna, 40126 Bologna, Italy.
慢性阻塞性肺病 (COPD) 的过度诊断影响了近一半的患者,过度治疗也很常见. 遵守诊断指南,特别是螺旋计,对于改善COPD患者护理和资源配置至关重要.
科学领域:
- 肺部医学 肺部医学
- 诊断的准确性 诊断的准确性
- 医疗保健管理的管理
背景情况:
- 慢性阻塞性肺病 (COPD) 的诊断严重依赖于临床评估.
- 过度诊断和过度治疗COPD是临床实践中的重大问题.
- 目前的诊断指南强调螺旋测量,但遵守情况各不相同.
研究的目的:
- 为了估计COPD过度诊断和过度治疗的患病率.
- 根据不同的螺旋测量标准 (GOLD,LLN) 和环境 (医院,初级保健) 分析诊断和治疗率.
- 突出需要更好地遵守COPD诊断指南的需要.
主要方法:
- 42项观察性研究的元分析.
- 包括39个数据集 (23,765名受试者) 过度诊断和14个研究 (8,183名受试者) 过度治疗.
- 根据全球COPD倡议 (GOLD) 和下限正常 (LLN) 标准分层,并按医院与初级保健机构进行分层.
主要成果:
- 综合COPD过度诊断的流行率为42.0% (GOLD) 和48.2% (LLN).
- 综合的COPD过度治疗的流行率为57.1% (GOLD) 和36.3% (LLN).
- 与医院设置相比,在初级保健中观察到更高的过度诊断率.
结论:
- 很大一部分患者被错误地诊断为COPD,特别是当不使用螺旋计时.
- 错误的诊断导致严重的过度治疗,造成不良影响和资源效率低下.
- 迫切需要采取战略,以加强遵守既定的COPD诊断指南.
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