Summerton Nicholas, Mann Sara, Rigby Alan S, Ashley Julie, Palmer Sarah, Hetherington John W
Department of Primary Care, University of Hull.
Br J Gen Pract. 2002 Apr;52(477):284-9.
There is little information available to assist general practitioners (GPs) in deciding which patients with haematuria are likely to have a malignancy.
To derive discriminant functions for specific items or clusters of clinical history information in relation to the categorisation of patients presenting to the 'open access' haematuria clinic in Hull.
Recruitment of patients via an 'open-access' haematuria clinic.
A consecutive series of 363 patients aged between 18 and 80 years who attended the clinic.
Between February 1999 and October 1999 clinical history information derived from the participating patients was compared with the patients' diagnoses. Diagnoses were established by a combination of cystoscopy and radiological assessments and rechecked against the patient records and the hospital patient administration system two to three months later.
A number of individual variables seemed to be particularly helpful in discriminating malignancies. However, when indicants were combined using regression shrinkage techniques, only the following variables were preserved: age, sex, type of haematuria, number of episodes of haematuria, hesitancy, poor urinary stream, smoking history, and history of urinary tract infections.
It is possible to generate helpful discriminant information to assist GPs in making more appropriate decisions in a difficult area of clinical practice. However, it remains a matter of judgement as to how representative the study population is likely to be compared with all haematuria patients encountered in primary care. We have reasonable confidence in the general applicability of the rules for macroscopic haematuria: however, it seems likely that the prediction rules outlined for microscopic haematuria have their greatest relevance once a patient has been referred by a GP. In developing the work further and testing out the discriminators identified in this study, we propose that a primary care-based project now needs to be undertaken focusing on microscopic haematuria with a particular emphasis on addressing selection biases. In addition, there is a more general need to assess the reliability of all the suggested items of clinical discriminant information.
几乎没有可用信息来帮助全科医生（GP）判断哪些血尿患者可能患有恶性肿瘤。
针对赫尔“开放式”血尿诊所就诊患者的分类，推导与临床病史信息的特定项目或类别相关的判别函数。
通过“开放式”血尿诊所招募患者。
连续363名年龄在18至80岁之间到该诊所就诊的患者。
1999年2月至1999年10月，将参与研究患者的临床病史信息与患者诊断结果进行比较。诊断通过膀胱镜检查和放射学评估相结合来确定，并在两到三个月后对照患者记录和医院患者管理系统进行复查。
一些个体变量似乎在鉴别恶性肿瘤方面特别有帮助。然而，当使用回归收缩技术合并指标时，仅保留了以下变量：年龄、性别、血尿类型、血尿发作次数、排尿犹豫、尿流不畅、吸烟史和尿路感染史。
有可能生成有用的判别信息，以帮助全科医生在临床实践的困难领域做出更合适的决策。然而，与初级保健中遇到的所有血尿患者相比，该研究人群的代表性如何仍有待判断。我们对肉眼血尿规则的普遍适用性有合理的信心：然而，对于镜下血尿概述的预测规则，似乎在患者由全科医生转诊后其相关性最大。在进一步开展这项工作并测试本研究中确定的判别因素时，我们建议现在需要开展一个基于初级保健的项目，重点关注镜下血尿，特别强调解决选择偏倚问题。此外，更普遍地需要评估所有建议的临床判别信息项目的可靠性。
