提供者图表注释和基于指南的喘严重程度分类的一致性
Hillary Kroll1,2, Termeh Feinberg3, Gary K Soffer4,5
1Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA.
概括
医生图表说明显示间歇性喘严重程度的良好协议,但与指导方针相比,对于非间歇性喘的分类有所不同. 对这种不一致的认识对于准确的青少年喘管理至关重要.
科学领域:
- 儿科肺病学 儿科肺病学
- 临床实践指南 临床实践指南
- 喘管理 喘管理
背景情况:
- 准确的喘严重程度分类对于青少年有效治疗至关重要.
- 医生图表注释是记录喘严重程度的常见方法.
- 基于指南的标准为喘评估提供了一种标准化的方法.
研究的目的:
- 评估医生图表注释与指导方针为青少年喘严重程度分类的标准之间的一致性.
- 确定临床实践与既定指南之间的喘严重程度评估中的潜在差异.
主要方法:
- 一项涉及203名被诊断患有喘的城市青少年 (13-18岁) 的研究.
- 使用灵敏度,特异性,正预测值,加权卡帕系数和麦克内马尔测试来评估一致性.
- 2007年国家喘教育和预防计划 (NAEPP) 准则被用作黄金标准.
主要成果:
- 医生表格注释表明间歇性喘的高灵敏度 (95%).
- 对于非间歇性分类 (轻度,中度,严重持续性) 的一致性显示出公平与良好之间的一致性 (kappa值0.36-0.66).
- 总体一致性各不相同,间歇性喘的一致性最高 (kappa=0.88).
结论:
- 在不同城市青少年中,医生文档和NAEPP指南之间对非间歇性喘严重程度的分类存在显著差异.
- 医生应该意识到潜在的异常,并使用准确分类和治疗的指南.
- 更好地遵守指南可能会提高青少年的喘护理.
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