Xu Jinping, Schwartz Kendra, Monsur Joseph, Northrup Justin, Neale Anne Victoria
Department of Family Medicine, Wayne State University, Detroit, MI 48201, USA.
Fam Pract. 2004 Dec;21(6):599-604. doi: 10.1093/fampra/cmh604. Epub 2004 Nov 4.
Despite substantial use of the telephone in health care, only a few studies have formally evaluated the appropriateness of telephone-based management for acute medical problems. The accuracy of patients' report of signs and symptoms remains unknown.
We compared the agreement between patient self-assessment and clinician assessment on the typical signs and symptoms of group A beta-haemolytic Streptococcus (GABHS) to investigate the potential difficulties of using patient self-report to triage sore throat patients.
In this cross-sectional study, each of 200 adult pharyngitis patients was instructed to examine him/herself and to record the symptoms and physical findings. Two clinicians independently interviewed and examined each patient and recorded their findings. Each patient then had a rapid GABHS antigen test, the results of which were blinded to both clinicians and patients. Each patient self-assessment was compared with the findings of each clinician, and the agreement and disagreement between them computed.
We found varying levels of agreement (kappa=-0.05 to 0.71) between patients and clinicians on sore throat history and physical assessments. Importantly, there was fair to substantial agreement (kappa=0.20-0.71) on the key signs and symptoms used in GABHS clinical prediction rules. As expected, history items had the highest agreement (kappa=0.52-0.71). Patients were more likely than clinicians to report rather than deny a specific physical sign.
Adult sore throat patients may reliably report their symptoms, but may not be able to assess and report accurately on relevant physical signs of pharyngitis. Patients have a tendency to over-report physical signs. This study indicates the potential difficulties associated with telephone triage of sore throat patients, or other illnesses that require assessment of physical signs.
尽管电话在医疗保健中得到大量使用，但仅有少数研究正式评估了基于电话的急性医疗问题管理的适宜性。患者对体征和症状报告的准确性尚不清楚。
我们比较了患者自我评估与临床医生对A组β溶血性链球菌（GABHS）典型体征和症状评估之间的一致性，以调查使用患者自我报告对咽痛患者进行分诊时可能存在的困难。
在这项横断面研究中，指导200名成年咽炎患者各自进行自我检查，并记录症状和体格检查结果。两名临床医生分别对每位患者进行访谈和检查，并记录他们的发现。然后每位患者进行GABHS快速抗原检测，检测结果对临床医生和患者均保密。将每位患者的自我评估与每位临床医生的检查结果进行比较，并计算两者之间的一致性和不一致性。
我们发现患者与临床医生在咽痛病史和体格检查评估方面的一致性水平各不相同（kappa值为-0.05至0.71）。重要的是，在GABHS临床预测规则中使用的关键体征和症状方面存在中等至高度一致性（kappa值为0.20 - 0.71）。正如预期的那样，病史项目的一致性最高（kappa值为0.52 - 0.71）。患者比临床医生更倾向于报告而非否认特定的体征。
成年咽痛患者可能能够可靠地报告其症状，但可能无法准确评估和报告咽炎的相关体征。患者有过度报告体征的倾向。这项研究表明了咽痛患者或其他需要评估体征的疾病进行电话分诊时存在的潜在困难。
