How physicians evaluate patients with dementia who present with shortness of breath.
How physicians evaluate patients with dementia who present with shortness of breath.
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DOI：
10.1111/jgs.17438
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发表时间：
2022-01
影响因子：
6.3
通讯作者：
Shekelle PG
中科院分区：
文献类型：
--
作者：
Ly DP;Shekelle PG
患者中痴呆的存在是否使医生难以评估此类患者可能患有肺栓塞（PE）等严重疾病的风险尚不清楚。我们的目的是检查四个临床因素（DVT/PE，恶性肿瘤，最近的手术，心动过速）与PE测试痴呆患者相比，非痴呆患者的差异性关联。我们对2011年至2018年期间104家VA医院的急诊科（艾德）就诊进行了一项横断面研究，患者年龄60岁及以上，呼吸急促。我们的结果是PE测试（CT扫描和/或D-二聚体），随后诊断为急性PE。样本包括7，124名艾德医生的593，001例患者访视。5.6%的样本患有痴呆症。10.6%接受PE检查。四个临床因素中有三个与痴呆患者的PE测试相关性较低。例如，在考虑到基线时医生对痴呆患者进行PE测试的可能性比非痴呆患者低0.9个百分点后，医生对患有心动过速的痴呆患者进行测试的可能性比患有心动过速的非痴呆患者低2.6个百分点。我们没有发现证据表明，任何临床因素检查有一个差异较低的相关性与随后诊断的急性PE痴呆患者。与非痴呆患者相比，已知可预测PE风险的临床因素与痴呆患者的PE检测相关性较低。这些结果可能与医生在评估痴呆患者时更经常忽略这些临床因素一致，但也与医生认识到这些因素但在决策过程中不使用它们一致。进一步了解医生如何评估具有常见急性症状的痴呆患者可能有助于改善对此类患者的护理。
Whether the presence of dementia in patients makes it difficult for physicians to assess the risk such patients might have for serious conditions such as pulmonary embolism (PE) is unknown. Our objective was to examine the differential association of four clinical factors (DVT/PE, malignancy, recent surgery, tachycardia) with PE testing for patients with dementia compared to patients without dementia. We performed a cross-sectional study of emergency department (ED) visits to 104 VA hospitals from 2011-2018 by patients 60 and over presenting with shortness of breath (SOB). Our outcomes were PE testing (CT scan and/or D-dimer) and subsequently diagnosed acute PE. The sample included 593,001 patient visits for SOB across 7,124 ED physicians. 5.6% of the sample had dementia. 10.6% received PE testing. Three of the four clinical factors examined had a lower association with PE testing for patients with dementia. For example, after taking into account that at baseline physicians were 0.9 percentage points less likely to test patients with dementia than patients without dementia for PE, physicians were an additional 2.6 percentage points less likely to test patients with dementia who had tachycardia than patients without dementia who had tachycardia. We failed to find evidence that any clinical factor examined had a differentially lower association with a subsequently diagnosed acute PE for patients with dementia. Clinical factors known to be predictive of PE risk had a lower association with PE testing for patients with dementia compared to patients without dementia. These results may be consistent with physicians missing these clinical factors more often when evaluating patients with dementia, but also with physicians recognizing such factors but not using them in the decision-making process. Further understanding how physicians evaluate patients with dementia presenting with common acute symptoms may help improve the care delivered to such patients.
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影响因子：
5.7
作者：
Levine, Deborah A.;Langa, Kenneth M.;Nallamothu, Brahmajee K.
通讯作者：
Nallamothu, Brahmajee K.
影响因子：
9.9
作者：
Saposnik, G.;Cote, R.;Black, S. E.
通讯作者：
Black, S. E.
DOI：
10.3233/jad-200700
发表时间：
2020
期刊：
Journal of Alzheimer's disease : JAD
影响因子：
--
作者：
Blair EM;Zahuranec DB;Langa KM;Forman J;Reale BK;Kollman C;Giordani B;Levine DA
通讯作者：
Levine DA
影响因子：
39.2
作者：
Wells, PS;Ginsberg, JS;Hirsh, J
通讯作者：
Hirsh, J
影响因子：
39.2
作者：
Wells, PS;Anderson, DR;Kovacs, MJ
通讯作者：
Kovacs, MJ