Understanding variability in physician ratings of the appropriateness of coronary angiography after acute myocardial infarction.

Understanding variability in physician ratings of the appropriateness of coronary angiography after acute myocardial infarction.
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了解医生对急性心肌梗死后冠状动脉造影的适宜性评价的变异性。

DOI:
10.1016/s0895-4356(98)00166-8
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发表时间:
1999
影响因子:
7.2
通讯作者:
Normand,SL
Normand,SL
中科院分区:
医学2区
文献类型:
--
作者:
Landrum,MB;McNeil,BJ;Silva,L;Normand,SL

文献摘要

参考文献

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我们研究了急性心肌梗死(AMI)后890例临床情况(适应症)的冠状动脉造影适当性评级的变异性,这些临床情况(适应症)来自一个由9名成员组成的多专业小组,作为小组特征和临床适应症属性的函数。我们在评级中记录了相当程度的可靠性。然而,专家之间的关键差异,他们的整体倾向得分高,他们的信念的影响,临床因素的适当性进行了鉴定。年龄、心脏并发症、AMI后心绞痛和无创性检查结果是与冠状动脉造影术的适当性评级最密切相关的临床因素。需要进一步研究冠状动脉造影术在老年患者和休克、肺水肿和无症状性缺血患者中的有效性,以提高我们对该手术在这些患者中的适当性的认识。
We examined variability in ratings of the appropriateness of coronary angiography for 890 clinical scenarios (indications) after an acute myocardial infarction (AMI) from a nine-member multispecialty panel as a function of panel characteristics and the attributes of the clinical indications. We documented a substantial degree of reliability in the ratings. However, key differences among the experts in terms of both their overall propensity to score high and their beliefs regarding the impact of clinical factors on appropriateness were identified. Age, cardiac complications, post-AMI angina, and noninvasive test results were the clinical factors most strongly related to appropriateness ratings for coronary angiography. Further research on the effectiveness of coronary angiography in older patients and in patients with shock, pulmonary edema, and silent ischemia is needed to improve our knowledge about the appropriateness of this procedure in these patients.
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