在急性缺血性中风患者中使用气泡研究进行心声回报的收益率
Jonathan Hu1, Anson Yoong-Chee Lee1, Kazuma Nakagawa2
1John A. Burns School of Medicine, University of Hawaii, Honolulu, HI 96813, USA.
Journal of clinical medicine
|November 9, 2024
概括
泡研究 (BSs) 检测专利卵孔 (PFO) 在没有密码性中风 (CS) 的中风患者中过度使用,导致医疗保健浪费. 指导方针建议将PFO关闭限制在60岁以下的CS患者身上,但许多BS被执行不当.
科学领域:
- 心脏病学 心脏病学
- 神经学 神经学
- 诊断成像 诊断成像 诊断成像
背景情况:
- 胸间 (TTE) 和食道间 (TEE) 的心声波泡研究 (BSs) 在密码性中风 (CS) 中诊断出 patent foramen ovale (PFO).
- 目前的指导方针将PFO关闭建议限制在60岁或更年轻的CS患者.
- 在老年患者或已知中风病因的患者中,BS经常被执行,不管指导方针如何.
研究的目的:
- 评估心声波泡研究在急性缺血性中风患者中的利用.
- 评估已确定的中风病因病理与密码性中风患者的诊断产量和对BSs管理的影响.
- 鉴定因过度使用与当前临床指南不一致的诊断研究而导致的潜在医疗保健浪费.
主要方法:
- 对2021年1月至2022年6月期间入院的急性缺血性中风患者的回顾性单中心研究.
- 分析中风病因和TTE和TEE的数量,并进行了泡研究.
- 评估PFO诊断和随后的PFO关闭程序.
主要成果:
- 在663名患者中,413名 (62.3%) 患有非密码性中风 (非CS).
- 进行了390次TTE和40次TEE与BS;相当一部分 (252次TTE,17次TEE) 是非CS患者.
- 在36名CS患者和18名非CS患者中发现了PFO,但只有14名PFO关闭发生,主要是用于预防中风的CS患者.
结论:
- 大多数在非脑脊髓病患者中进行的泡研究没有改变治疗方法,这表明有明显的诊断过度使用.
- 这种过度使用有助于医疗保健的浪费,并未得到PFO关闭的当前临床指南的支持.
- 建议实施新的机构协议,以提高运营效率,减少缺血性中风护理中不必要的诊断测试.
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