van Duijn N P, Brouwer H J, Lamberts H
Department of General Practice, University of Amsterdam, Netherlands.
BMJ. 1992 Sep 19;305(6855):684-7. doi: 10.1136/bmj.305.6855.684.
To establish the incidence of maxillary sinusitis in general practice and the predictive value of symptoms and signs.
Population based study.
9 general practices with 15,220 patients aged 15 years and older on the list.
400 patients with 441 episodes in whom practitioners intended to confirm or to exclude sinusitis.
Results of ultrasonography and signs and symptoms associated with positive results.
212 of the 441 episodes were confirmed by ultrasonography. 15.7 episodes occurred per 1000 adults per year. The five symptoms beginning with common cold (beta coefficient = 1.035), purulent rhinorrhoea (0.996), pain at bending (0.950), unilateral maxillary pain (0.640), and pain in teeth (0.606) were associated with positive results on ultrasonography. General practitioners' clinical diagnoses were correct in 177 episodes, false positive in 88, false negative in 22, and uncertain in 154. With an algorithm using the five weighted symptoms 243 of the diagnoses would have been correct, but 110 would remain uncertain and 44 cases would have been missed.
The five symptoms algorithm would improve diagnostic accuracy of general practitioners, but incorrect and uncertain diagnoses cannot be avoided.
确定全科医疗中上颌窦炎的发病率以及症状和体征的预测价值。
基于人群的研究。
9家全科诊所，登记在册的15岁及以上患者有15220名。
400例患者共出现441次发作，医生试图确诊或排除鼻窦炎。
超声检查结果以及与阳性结果相关的体征和症状。
441次发作中，212次经超声检查确诊。每年每1000名成年人中有15.7次发作。以普通感冒开始的五种症状（β系数=1.035）、脓性鼻漏（0.996）、弯腰时疼痛（0.950）、单侧上颌疼痛（0.640）和牙痛（0.606）与超声检查阳性结果相关。全科医生的临床诊断在177次发作中正确，88次为假阳性，22次为假阴性，154次不确定。使用这五种加权症状的算法，243次诊断会是正确的，但仍有110次不确定，44例病例会被漏诊。
五种症状算法可提高全科医生的诊断准确性，但无法避免错误和不确定的诊断。
