Chacko Karen M, Feinberg Lawrence E
Division of General Internal Medicine, University of Colorado Health Sciences Center, Denver, Colorado, USA.
Am J Prev Med. 2007 Jan;32(1):59-62. doi: 10.1016/j.amepre.2006.09.002.
Routine laboratory screening at preventive health exams continues to be a common practice despite expert opinion dating back to 1979 that supports only a few screening tests for apparently healthy adults. This report describes trends in such testing over a 27-year period.
Primary care physicians were surveyed five times between 1978 and 2004 at a yearly educational meeting in Colorado. Based on case vignettes describing two apparently healthy adults, physicians indicated which laboratory tests they would routinely order.
Of a total of 2364 surveys collected during years 1978, 1983, 1988, 1999, and 2004, the corresponding percentage of physicians respondents who state they would order the following tests for a healthy man aged 35 years were: complete blood count (CBC) (87, 75, 73, 49, 46); urinalysis (UA) (93, 86, 79, 52, 44); chemistry panel (CHEM) (57, 48, 36, 43, 55); and electrocardiogram (ECG) (37, 27, 24, 9, 6). For a healthy woman aged 55 years, the corresponding percentages for each test were: CBC (89, 89, 86, 64, 67); UA (96, 93, 88, 62, 55); CHEM (70, 70, 66, 57, 76); ECG (63, 51, 51, 33, 29); and thyroid stimulating hormone (14, 20, 28, 42, 57).
Although currently practicing physicians continue to report that they order screening tests for apparently healthy people, this practice appears to have decreased over the past 27 years. This trend may reflect expert guidelines and emphasis on medical cost containment.
尽管自1979年以来专家意见就支持仅对表面健康的成年人进行少数几项筛查测试，但预防性健康检查中的常规实验室筛查仍是一种常见做法。本报告描述了27年间此类检测的趋势。
1978年至2004年期间，在科罗拉多州的一次年度教育会议上，对初级保健医生进行了五次调查。根据描述两名表面健康成年人的病例 vignettes，医生指出他们会常规安排哪些实验室检测。
在1978年、1983年、1988年、1999年和2004年收集的总共2364份调查问卷中，表示会为一名35岁健康男性安排以下检测的医生受访者的相应百分比分别为：全血细胞计数（CBC）（87、75、73、49、46）；尿液分析（UA）（93、86、79、52、44）；化学检查（CHEM）（57、48、36、43、55）；以及心电图（ECG）（37、27、24、9、6）。对于一名55岁健康女性，每项检测的相应百分比分别为：CBC（89、89、86、64、67）；UA（96、93、88、62、55）；CHEM（70、70、66、57、76）；ECG（63、51、51、33、29）；以及促甲状腺激素（14、20、28、42、57）。
尽管目前执业医生仍报告他们会为表面健康的人安排筛查测试，但在过去27年中这种做法似乎有所减少。这种趋势可能反映了专家指南以及对医疗成本控制的重视。
