Symptom Reports Are Not Reliable During Ambulatory Reflux Monitoring
Symptom Reports Are Not Reliable During Ambulatory Reflux Monitoring
复制标题
DOI：
10.1038/ajg.2012.342
复制
发表时间：
2012-12-01
影响因子：
9.8
通讯作者：
Vaezi, Michael F.
中科院分区：
文献类型：
--
作者：
Kavitt, Robert T.;Higginbotham, Tina;Vaezi, Michael F.
注意事项：患者在动态反流监测期间报告症状事件通常很少有关于其准确性的数据。我们采用了一种新的时间同步的动态音频记录的症状事件，同时延长pH值/阻抗monitoring，以评估患者报告的symptoms.METHODS时间的准确性：声学监测系统被用来检测咳嗽事件，通过气管和胸壁的声音，它是时间同步的动态阻抗/pH值监测系统。指导患者以常规方式记录其症状。六名独立的观察员独立地听了24小时的录音，并记录了每次咳嗽事件的确切时间。患者对研究设计不知情，音频审查员对自己的报告以及患者和其他审查员的报告不知情。同时的音频记录和患者报告的症状进行了测试，为三个独立的时间阈值：1，2，和5分钟。结果：中位数（四分位数范围（IQR））的咳嗽事件的音频检测是显着（P <0.001）高于患者报告的：216（90 - 275）和34（22 - 60），分别。录音听众之间的一致性（基本到几乎完美的一致性; kappa = 0.77 - 0.82）显著（P <0.001）高于录音和患者报告的症状之间的一致性（轻微到一般的一致性; kappa = 0.13 - 0.27）。患者没有报告91，82，和71%的可闻咳嗽事件的基础上1，2，和5分钟的一致性时间窗口，分别conclusions：我们发现，患者不报告他们的症状，即使在5分钟的时间窗口内的真实事件，并建议谨慎的临床决策仅基于症状指数在动态反流监测。
OBJECTIVES: Patient reporting of symptom events during ambulatory reflux monitoring is commonly performed with little data regarding its accuracy. We employed a novel time-synchronized ambulatory audio recording of symptom events simultaneously with prolonged pH/impedance monitoring to assess temporal accuracy of patient-reported symptoms.METHODS: An acoustic monitoring system was employed to detect cough events via tracheal and chest wall sounds and it was temporally synchronized with an ambulatory impedance/pH monitoring system. Patients were instructed to record their symptoms in the usual manner. Six separate observers independently listened to the 24-h audio recordings and logged the exact timing of each cough event. Patients were blinded to study design and the audio reviewers were blinded to their own reports and those of patients and other reviewers. Concurrence of audio recordings and patient-reported symptoms were tested for three separate time thresholds: 1, 2, and 5 min.RESULTS: The median (interquartile range (IQR)) number of cough events by audio detection was significantly (P < 0.001) higher than those reported by patients: 216 (90-275) and 34 (22-60), respectively. There was significantly (P < 0.001) higher agreement among the audio recording listeners (substantial to almost perfect agreement; kappa = 0.77-0.82) than between the audio recording and patient-reported symptoms (slight to fair agreement; kappa = 0.13-0.27). Patients did not report 91, 82, and 71% of audible cough events based on 1-, 2-, and 5-min concordance time windows, respectively.CONCLUSIONS: We found that patients do not report the majority of their symptoms during ambulatory reflux monitoring even within a 5-min time window of the true event and advise caution in clinical decision-making based solely on symptom indices.