A comparison of criterion standard methods to diagnose acute heart failure.
A comparison of criterion standard methods to diagnose acute heart failure.
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诊断急性心力衰竭的标准方法比较。
DOI：
10.1111/j.1751-7133.2012.00288.x
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Storrow,AlanB
中科院分区：
文献类型：
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作者：
Collins,SeanP;Lindsell,ChristopherJ;Yealy,DonaldM;Maron,DavidJ;Naftilan,AllenJ;McPherson,JohnA;Storrow,AlanB
©2012 Wiley Periodicals Inc.作者试图比较和对比急诊科（艾德）患者队列中目前用于诊断急性心力衰竭综合征（AHFS）的临床标准。在一项对有AHFS体征和症状的患者进行的前瞻性观察性研究中，检查了3项标准：（1）治疗艾德医生的诊断;（2）出院诊断;（3）心脏病专家小组基于病历审查的诊断。使用Cohen的kappa（κ）系数，作者评估了一致性，然后通过重复设置一个作为标准标准，另两个作为指标检验，比较不同的标准。共入组483例患者。在所有的标准中，AHFS患者比没有AHFS的患者更可能有AHFS病史，体格检查和胸部X线检查时出现充血，以及利钠肽水平升高。标准一致性良好（心脏病学审查与出院诊断，κ=0.74;心脏病学审查与艾德诊断，κ=0.66;艾德诊断与出院诊断，κ=0.59）。每种方法的敏感性相似，但特异性不同。不同的标准从接受AHFS评估的患者中识别不同的患者。研究人员在评估新的指数测试时，在各种标准方法之间进行选择时应该考虑这一点。
©2012 Wiley Periodicals Inc.The authors sought to compare and contrast the clinical criterion standards currently used in a cohort of emergency department (ED) patients to diagnose acute heart failure syndromes (AHFS). In a prospective observational study of patients with signs and symptoms of AHFS, 3 criterion standards were examined: (1) the treating ED physician’s diagnosis; (2) the hospital discharge diagnosis; and (3) a diagnosis based on medical record review by a panel of cardiologists. Using Cohen’s kappa (κ) coefficient, the authors assessed agreement and then compared the different standards by repeatedly setting one as the criterion standard and the other two as index tests. A total of 483 patients were enrolled. Across all criterion standards, patients with AHFS were more likely to have a history of AHFS, congestion on physical examination and chest radiography, and elevated natriuretic peptide levels than those without AHFS. The standards agreed well (cardiology review vs hospital discharge diagnosis, κ=0.74; cardiology review vs ED diagnosis, κ=0.66; ED diagnosis vs hospital discharge diagnosis κ=0.59). Each method had similar sensitivity but differing specificities. Different criterion standards identify different patients from among those being evaluated for AHFS. Researchers should consider this when choosing between the various criterion standard approaches when evaluating new index tests.