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Neurology:现代影像学时代脑血管事件的急诊科误诊率如何?

2017-03-31 xing.T MedSci原创

大约9%的脑血管事件在初次ED就诊时没有发现。当出现神经系统症状较轻微、非特异性或暂时性时,误诊的风险要大得多(范围为24%-60%)。这种差异表明很多误诊与症状特异性因素相关。对于误诊风险最大的症状特异性亚群,未来的研究应强调研究的原因和设计减少误诊的策略。

急诊科(ED)是误诊风险较高的科室,近日,神经病学领域权威取杂志Neurology上发表了一篇荟萃分析文章,研究人员试图估计ED识别急性脑血管事件的诊断准确性。

研究人员检索了MEDLINE和Embase数据库,查找报告了缺血性脑卒中、TIA或蛛网膜下腔出血(SAH)ED诊断准确性的研究(1995-2016)。两位独立审稿人确定纳入的研究。研究人员找到了1693个独特的引文,查阅了214篇文献全文,并分析了23项研究。研究被根据偏倚风险(QUADAS-2)进行排列,提取诊断数据。研究人员前瞻性地定义了临床表现亚群来比较误诊率。

纳入的研究报告15721例患者,研究的偏倚风险较低。脑血管病因的整体敏感性(91.3%(95%可信区间(CI)为90.7-92])和特异性(92.7%[91.7-93.7])较高,但是根据临床表现,有显著的变化。研究人员发现在症状较轻(正常与不正常的精神状态的SAH;假阴性率为23.8% vs. 4.2%,比值比[OR]为7.03 [4.8-10.31])、非特异性(头晕与运动表现;假阴性率为39.4% vs. 4.4%,OR为14.22[9.76-20.74])或短暂(TIA与缺血性脑卒中;错误发现率为59.7% vs. 11.7%,OR为11.21[6.66-18.89])的亚群中误诊更加常见。

大约9%的脑血管事件在初次ED就诊时没有发现。当出现神经系统症状较轻微、非特异性或暂时性时,误诊的风险要大得多(范围为24%-60%)。这种差异表明很多误诊与症状特异性因素相关。对于误诊风险最大的症状特异性亚群,未来的研究应强调研究的原因和设计减少误诊的策略。

原始出处:


Alexander Andrea Tarnutzer,et al. ED misdiagnosis of cerebrovascular events in the era of modern neuroimaging. Neurology. 2017. http://www.neurology.org/content/early/2017/03/29/WNL.0000000000003814.short

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    2017-05-08 yinhl1978
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    2017-04-03 天涯183

    非常好的文章,学习了

    0

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    2017-04-01 天涯183

    非常好的研究

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1974204, encodeId=164319e4204c0, content=<a href='/topic/show?id=44e991854f4' target=_blank style='color:#2F92EE;'>#误诊率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91854, encryptionId=44e991854f4, topicName=误诊率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6eb32500176, createdName=luckyshitiancai_42705684, createdTime=Tue Apr 25 12:27:00 CST 2017, time=2017-04-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1643443, encodeId=404c164344305, content=<a href='/topic/show?id=6236895092b' target=_blank style='color:#2F92EE;'>#血管事件#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89509, encryptionId=6236895092b, topicName=血管事件)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f99523187183, createdName=hukaixun, createdTime=Sun Nov 19 23:27:00 CST 2017, time=2017-11-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1999858, encodeId=c210199985841, content=<a href='/topic/show?id=d5df12695e6' target=_blank style='color:#2F92EE;'>#Neurol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12695, encryptionId=d5df12695e6, topicName=Neurol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8217292, createdName=yinhl1978, createdTime=Mon May 08 00:27:00 CST 2017, time=2017-05-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=184943, encodeId=ff7c18494393, content=非常好的文章,学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=108, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Mon Apr 03 23:22:52 CST 2017, time=2017-04-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1282168, encodeId=053b12821685c, content=<a href='/topic/show?id=4fd952582f1' target=_blank style='color:#2F92EE;'>#急诊科#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52582, encryptionId=4fd952582f1, topicName=急诊科)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=570c172, createdName=tigerlr98, createdTime=Sun Apr 02 05:27:00 CST 2017, time=2017-04-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=184369, encodeId=6656184369ac, content=非常好的研究, beContent=null, objectType=article, channel=null, level=null, likeNumber=139, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Sat Apr 01 21:17:00 CST 2017, time=2017-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=184331, encodeId=979218433192, content=有意思,也有意义, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLCclExeQ6LOGMD4dTsia4Ty4HtZCxRmG5vO5XIKfKX3a3vusfhHSej4Iib517vmhFW7RQgh7bpDp1yw/0, createdBy=50951609779, createdName=baihao215, createdTime=Sat Apr 01 15:01:24 CST 2017, time=2017-04-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=184093, encodeId=193c18409358, content=减少误诊,抢救生命, beContent=null, objectType=article, channel=null, level=null, likeNumber=107, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Fri Mar 31 21:42:05 CST 2017, time=2017-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=184058, encodeId=f1de184058b3, content=这篇写的非常不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=156, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7cde98330, createdName=milkshark, createdTime=Fri Mar 31 17:14:16 CST 2017, time=2017-03-31, status=1, ipAttribution=)]
    2017-04-01 baihao215

    有意思,也有意义

    0

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    2017-03-31 1ddf0692m34(暂无匿称)

    减少误诊,抢救生命

    0

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    2017-03-31 milkshark

    这篇写的非常不错

    0

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