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医生对老年患者昏迷的初始诊断策略的看法,没有诊断线索
Stephanie Happ1, Satish R Raj1, Derek Chew1
1Department of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.
概括
医生的偏好因是否首先使用植入式心脏监测 (ICM) 或倾斜表测试 (TTT) 对于未解释的昏迷的老年人而有所不同. 国际平衡存在,欧洲和北美之间存在区域差异.
科学领域:
- 心脏病学 心脏病学
- 电子生理学 电子生理学
- 诊断策略 诊断策略
背景情况:
- 在50岁以上没有心脏病的成年人中,昏迷的原因在41%的病例中不清楚.
- 目前的指导方针建议植入式心脏监测 (ICM) 和倾斜表测试 (TTT) 用于诊断.
- 医生对初始诊断测试的偏好仍然是未知的.
研究的目的:
- 调查医生关于在没有结构性或电气性心脏病的老年人中昏迷的最佳一线调查的意见.
- 了解植入式心脏监测 (ICM) 和倾斜表测试 (TTT) 之间的偏好.
主要方法:
- 一个在线调查分发给医生评估昏迷患者.
- 该调查收集了有关诊断策略,测试可用性和医生价值观的数据,这些数据涉及测试准确性和临床结果.
- 71名医生,主要是心脏电生理学家,完成了调查.
主要成果:
- 大多数医生 (62%) 认为最佳的第一次测试取决于临床情景;30%更喜欢ICM,8%更喜欢TTT.
- 无论是ICM还是TTT都在临床场所广泛使用.
- 北美 (85%) 的医生更喜欢ICM,而欧洲 (75%) 的医生更喜欢TTT,区域差异很大 (p=0.024).
- 对错过诊断的担忧对于TTT (61%) 比ICM (19%) 更高.
- 经过负的初始测试,ICM更有可能被推 (39%) 比TTT (11%),和警的等待是更常见的经过负的ICM (45%) 比TTT (11%;p<0.001).
结论:
- 对于老年人不明原因昏迷的首选初始诊断策略 (ICM vs. TTT) 有国际上的平衡.
- 在北美和欧洲之间,测试偏好存在显著的区域差异.
- 医生对错过诊断的担忧以及测试后的管理影响了测试选择.
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