专业咨询和诊断测试准确度在简要解决了不明原因事件后:一个多中心观测研究
Nassr Nama1, Praveen Jayson Rajasegaran2, Lauren M McDaniel1
1Division of Hospital Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, Washington.
Hospital pediatrics
|June 16, 2025
概括
婴儿短暂解决的不明原因事件 (BRUE) 的诊断测试和咨询是常见的,但很少产生重大发现. 建议重新考虑没有特定临床适应症的常规诊断方法.
科学领域:
- 儿科 儿科 儿科
- 新生儿科学 新生儿科学
- 紧急医疗 紧急医疗
背景情况:
- 目前关于短暂解决不明原因事件 (BRUE) 的指导方针主要针对较低风险的婴儿,对大多数婴儿的管理没有定义.
- 这项研究评估了所有患有BRUE的婴儿的诊断策略,而不仅仅是那些被认为低风险的婴儿.
研究的目的:
- 评估BRUE婴儿的各种测试和次专家咨询的诊断产量和准确性.
- 为更广泛的BRUE病例提供基于证据的管理策略.
主要方法:
- 在加拿大11家医院 (2017-2021) 中,对1042名患有BRUE的婴儿进行了回顾性队列研究.
- 在指数访问后90天内审查医疗记录,以确定诊断测试和新诊断的潜在疾病.
- 通过将测试结果与确认或可能的诊断进行比较来评估诊断准确性.
主要成果:
- 在855名被测试的婴儿中,只有8.4%的婴儿得到了解释性诊断,而64.8%的婴儿有无意义的发现.
- 全血细胞计数和心电图显示,对于常见的适应症,敏感性和特异性较低.
- 脑电图显示出更高的灵敏度和特异性,但肝酶,氨和血液培养等测试没有给出任何诊断.
- 四个实验室测试的假阳性率超过了50%:血液气体,代谢测试的先天性错误,电解质和胆红素.
- 咨询发现了27.7%的患者的解释性诊断和15.9%的患者的偶然发现.
结论:
- 对BRUE的诊断测试和咨询经常被使用,但很少产生重大诊断.
- 许多测试的准确性低,错误阳性率高,质疑它们的常规应用.
- 应重新考虑BRUE的常规诊断方法,除非存在特定的临床症状.
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