Recommendations for the recognition, diagnosis, and management of long COVID: a Delphi study.
Recommendations for the recognition, diagnosis, and management of long COVID: a Delphi study.
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DOI：
10.3399/bjgp.2021.0265
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发表时间：
2021-11
期刊：
影响因子：
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通讯作者：
Delphi panellists
中科院分区：
文献类型：
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作者：
Nurek M;Rayner C;Freyer A;Taylor S;Järte L;MacDermott N;Delaney BC;Delphi panellists
在缺乏对长期COVID的治疗和护理途径的研究的情况下，需要基于“新兴经验”的指导。为全科医生和长期COVID临床服务提供快速专家指南。一项德尔菲研究由一组初级和二级保健医生进行。就长期COVID的调查及管理提出建议。这些内容在线分发给一组对长期新冠肺炎感兴趣、有亲身经历和/或有治疗经验的英国医生（任何专业）。经过两轮德尔菲测试，小组成员表示同意每项建议（使用五点李克特量表），并提供评论。建议引起的反应“非常同意”，“同意”，或“既不同意也不反对”从90%或以上的响应者被视为显示共识。代表14个专业的33名临床医生就35项建议达成了共识。因此，全科医生应在存在广泛的表现特征（不限于疲劳和呼吸困难）的情况下考虑长期COVID，并在适当情况下排除鉴别诊断。应在初级保健中进行详细的病史和基线检查。进一步研究和特定治疗（心肌炎、体位性心动过速综合征、肥大细胞疾病）的适应症包括缺氧/去饱和、胸痛、心悸和组胺相关症状。康复应该是个性化的，仔细的活动起搏（以避免复发）和多学科的支持。长期COVID诊所应作为综合护理系统的一部分运作，全科医生在多学科团队中发挥关键作用。需要整体护理途径，调查特定并发症，管理潜在的症状群，以及量身定制的康复。
In the absence of research into therapies and care pathways for long COVID, guidance based on ‘emerging experience’ is needed. To provide a rapid expert guide for GPs and long COVID clinical services. A Delphi study was conducted with a panel of primary and secondary care doctors. Recommendations were generated relating to the investigation and management of long COVID. These were distributed online to a panel of UK doctors (any specialty) with an interest in, lived experience of, and/or experience treating long COVID. Over two rounds of Delphi testing, panellists indicated their agreement with each recommendation (using a five-point Likert scale) and provided comments. Recommendations eliciting a response of ‘strongly agree’, ‘agree’, or ‘neither agree nor disagree’ from 90% or more of responders were taken as showing consensus. Thirty-three clinicians representing 14 specialties reached consensus on 35 recommendations. Chiefly, GPs should consider long COVID in the presence of a wide range of presenting features (not limited to fatigue and breathlessness) and exclude differential diagnoses where appropriate. Detailed history and examination with baseline investigations should be conducted in primary care. Indications for further investigation and specific therapies (for myocarditis, postural tachycardia syndrome, mast cell disorder) include hypoxia/desaturation, chest pain, palpitations, and histamine-related symptoms. Rehabilitation should be individualised, with careful activity pacing (to avoid relapse) and multidisciplinary support. Long COVID clinics should operate as part of an integrated care system, with GPs playing a key role in the multidisciplinary team. Holistic care pathways, investigation of specific complications, management of potential symptom clusters, and tailored rehabilitation are needed.