Rosen M P, Sands D Z, Kuntz K M
Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
Acad Radiol. 2000 Jan;7(1):14-20. doi: 10.1016/s1076-6332(00)80438-9.
The purpose of this study was to measure physicians' utilities for outcomes after ventilation-perfusion lung scanning and to explore physicians' attitudes toward misdiagnosis and the treatment of patients suspected of having pulmonary embolism (PE) in a quantitative manner by using a utility analysis.
Before ordering lung scanning for suspected PE, physicians rated five possible outcomes on a scale of 0-100 by using a computer order-entry system. These responses were rescaled and transformed to a utility measure by using the Torrance transformation.
The mean utility for the potential outcomes after 341 lung scans were (a) no PE and no treatment (true-negative, 93 +/- 22 [mean +/- standard deviation]), (b) PE with appropriate treatment (true-positive, 84 +/- 24), (c) no PE but patient received treatment (false-positive, 54 +/- 32), (d) PE but patient did not receive treatment (false-negative, 14 +/- 23), and (e) death during pulmonary angiography (2 +/- 11). After lung scanning for acute PE, physicians placed greatest value on excluding the diagnosis (true-negative). Providing unnecessary treatment (false-positive) was valued in the midrange of utilities. The value of missing PE (false-negative) was rated almost equal to that of dying during pulmonary angiography.
Physicians consider providing treatment for PE without objective confirmation of an embolus to be preferable to missing a case of PE.
本研究旨在衡量医生对通气-灌注肺扫描后结果的效用，并通过效用分析以定量方式探讨医生对疑似肺栓塞（PE）患者误诊及治疗的态度。
在为疑似PE患者开具肺部扫描检查前，医生使用计算机医嘱录入系统对五种可能的结果按0至100分进行评分。这些回答经重新标度并通过托伦斯变换转换为效用度量。
341次肺部扫描后潜在结果的平均效用分别为：（a）无PE且未治疗（真阴性，93±22[均值±标准差]），（b）PE且接受适当治疗（真阳性，84±24），（c）无PE但患者接受了治疗（假阳性，54±32），（d）PE但患者未接受治疗（假阴性，14±23），以及（e）肺血管造影期间死亡（2±11）。对急性PE进行肺部扫描后，医生最看重排除诊断（真阴性）。提供不必要的治疗（假阳性）在效用范围中处于中等水平。漏诊PE（假阴性）的价值几乎与肺血管造影期间死亡的价值相当。
医生认为在未客观证实存在栓子的情况下对PE进行治疗比漏诊PE病例更可取。
