Real world evidence supports waking salivary cortisone as a screening test for adrenal insufficiency.
Real world evidence supports waking salivary cortisone as a screening test for adrenal insufficiency.
复制标题
现实世界的证据支持唤醒唾液可的松作为肾上腺功能不全的筛查测试。
DOI：
10.1111/cen.14975
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发表时间：
2023
影响因子：
3.2
通讯作者：
Debono M
中科院分区：
文献类型：
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作者：
Debono M
在世界范围内，成人和儿童面临肾上腺功能不全的风险，主要是由于感染性疾病和使用抗炎糖皮质激素引起的肾上腺抑制。家庭清醒唾液可的松是一种准确的肾上腺功能不全的筛查试验，它有可能降低成本，患者更喜欢它的促肾上腺皮质激素（ACTH）（synacthen）刺激试验。我们进行了一个服务评价家庭清醒的唾液可的松在临床护理，以确定实施barriers.Design，患者和MeasurementsService评价在一个中心，212例肾上腺皮质功能不全患者提到了一个清醒的唾液可的松。在测试过程中遇到的问题进行记录和患者的反馈，通过焦点小组，collected.ResultsFrom所有患者提供清醒的唾液可的松55%有一个正常的测试，23%肾上腺抑制，和22%的模棱两可的结果，需要临床中心ACTH刺激试验。唾液样本采集时间的中位数（四分位距[IQR]）为07：40（07：00-08：40）。从采集到（i）交付至当地实验室的中位（IQR）天数为1（0.25-2）天;（ii）当地实验室报告的中位（IQR）天数为13（11-18）天。患者认为该试验“容易进行”，并喜欢它比住院ACTH刺激试验。临床实施的主要挑战是结果报告给临床医生，由于延迟在当地laborator.ConclusionsThis服务评价提供了真实的-世界的证据，家庭清醒唾液可的松是一种有效的，实用的肾上腺功能不全的筛查试验。它确定了在将测试引入卫生服务时需要解决的测试实施的关键障碍。
ObjectiveWorldwide, adults and children are at risk of adrenal insufficiency largely due to infectious diseases and adrenal suppression from use of anti‐inflammatory glucocorticoids. Home waking salivary cortisone is an accurate screening test for adrenal insufficiency, it has potential to reduce costs, and patients prefer it to the adrenocorticotropin (ACTH) (synacthen) stimulation test. We carried out a service evaluation of home waking salivary cortisone in clinical care to identify implementation barriers.Design, Patients and MeasurementsService evaluation in a centre where 212 patients referred for adrenal insufficiency had a waking salivary cortisone. Problems encountered during testing were recorded and patient feedback, via focus groups, collected.ResultsFrom all patients providing a waking salivary cortisone 55% had a normal test, 23% adrenal suppression, and 22% an equivocal result requiring a clinical centre ACTH stimulation test. The median (interquartile range [IQR]) for the time of the saliva sample was 07:40 (07:00–08:40). The median (IQR) days between collection and (i) delivery to local laboratory was 1 (0.25–2) day; (ii) reporting by local laboratory was 13 (11–18) days. Patients considered the test is “easy to do” and preferred it to the inpatient ACTH stimulation test. The principal challenge to clinical implementation was results reporting to clinicians due to delays at the local laboratory.ConclusionsThis service evaluation provides real‐world evidence that home waking salivary cortisone is an effective, practical screening test for adrenal insufficiency. It identified key barriers to testing implementation that need to be addressed when introducing the test to a health service.