当全科医生没有血清尿酸检测时,痛风的诊断是不确定的:一项观察性研究
Hein Janssens1, Lisanne Houtappels2,3, Tjard Schermer2,4
1Department of Primary and Community Care, Radboudumc Research Institute for Medical Innovation, Radboud University Medical Centre, Nijmegen, The Netherlands. hein.janssens@radboudumc.nl.
Clinical rheumatology
|October 29, 2024
概括
一般医生 (GPs) 通常在不检测血清尿酸 (SUA) 的情况下诊断出痛风. 这种做法导致了严重的诊断不确定性,影响了患者护理和研究准确性.
科学领域:
- 类风湿病学 类风湿病学
- 主要护理医学 医疗保健
- 诊断的准确性 诊断的准确性
背景情况:
- 一般医生 (GPs) 管理大多数痛风诊断,严重依赖临床评估.
- 血清尿酸 (SUA) 含量超过0.35mmol/L是痛风临床诊断的关键决定因素.
- 一般医生在最初的痛风诊断中使用SUA测试的程度尚未确立.
研究的目的:
- 为了评估血清尿酸 (SUA) 测试的频率,一般医生在最初的痛风诊断期间.
- 评估不进行SUA测试对痛风诊断确定性的影响.
- 确定涉及痛风初级保健患者的临床护理和研究的后果.
主要方法:
- 在2013年至2022年期间,对来自荷兰的87家全科医院的7782名患者进行了回顾性分析.
- 计算了第一个痛风诊断和记录的SUA测试患者的比例.
- 评估了相对于诊断的SUA测试时间,SUA水平,以及与"急性痛风诊断规则" (AGD规则) 的一致性.
主要成果:
- 在43.0%的病例中,在痛风诊断时没有记录血清尿酸 (SUA) 测试结果.
- 当SUA水平>0.35 mmol/L被记录并及时检测时,大多数患者的痛风很有可能 (根据AGD规则"痛风很可能") 发生.
- 由于没有及时,高水平的SUA检测,导致"有疑问或不确定的痛风诊断",甚至是替代性关节炎诊断,特别是在女性身上.
结论:
- 大约40%的全科医生诊断的痛风缺乏血清尿酸 (SUA) 检测,造成了可避免的诊断不确定性.
- 这种诊断不确定性影响临床管理,并引入了包括初级保健痛风患者在内的研究研究中的潜在不准确性.
- 强调需要全科医生持续进行SUA测试以确定痛风诊断,研究人员需要考虑初级保健数据中的诊断模两可.
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