Weiss Clifford R, Haponik Edward F, Diette Gregory B, Merriman Barry, Scatarige John C, Fishman Elliot K
Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine,Baltimore, MD 21287-0801, USA.
Acad Radiol. 2008 Jan;15(1):3-14. doi: 10.1016/j.acra.2007.07.019.
To assess the pretest practices of US clinicians who treat patients with acute pulmonary embolism (PE).
We surveyed 855 practicing physicians selected randomly from three professional organizations. We asked participants to estimate how often and by what method they determine the likelihood of PE before they request confirmatory studies. Participants reported their awareness of four published clinical practice guidelines dealing with acute PE and selected options for further diagnostic testing after reviewing clinical data from three hypothetical patients presenting with low, intermediate, and high probability of acute PE.
We received completed surveys from 240 physicians practicing in 44 states. Although most (98.3%) report that they assess pretest probability of PE before testing, slightly more than half do so routinely. A total of 72.5% prefer an unstructured approach to pretest assessment, whereas 22.9% use published prediction rules. Most (93.0%) are aware of at least one published guideline for assessing acute PE, but only 44.2% report using one or more in daily practice. Respondents who use published prediction rules, estimate pretest probability routinely, or use at least one practice guideline were more likely to request additional testing when reviewing a low probability clinical scenario. No differences in testing frequency or preferences were observed for intermediate or high probability clinical scenarios.
The majority of clinicians we surveyed use an unstructured approach when estimating the pretest probability of acute PE. With the exception of low probability scenario, clinicians agreed on testing choices in suspected acute PE, regardless of the method or frequency of pre-test assessment.
评估治疗急性肺栓塞（PE）患者的美国临床医生的检测前实践。
我们对从三个专业组织中随机选取的855名执业医师进行了调查。我们询问参与者在要求进行确诊研究之前，他们估计确定PE可能性的频率以及采用的方法。参与者报告了他们对四项已发表的关于急性PE的临床实践指南的了解情况，并在查看了三名分别呈现急性PE低、中、高概率的假设患者的临床数据后，选择进一步诊断检测的选项。
我们收到了来自44个州的240名执业医师的完整调查问卷。尽管大多数（98.3%）报告称他们在检测前评估PE的概率，但只有略多于一半的人是常规进行。共有72.5%的人倾向于采用非结构化方法进行检测前评估，而22.9%的人使用已发表的预测规则。大多数（93.0%）知晓至少一项已发表的评估急性PE的指南，但只有44.2%的人报告在日常实践中使用一项或多项指南。在查看低概率临床情况时，使用已发表预测规则、常规估计检测前概率或使用至少一项实践指南的受访者更有可能要求进行额外检测。对于中概率或高概率临床情况，未观察到检测频率或偏好的差异。
我们调查的大多数临床医生在估计急性PE的检测前概率时采用非结构化方法。除了低概率情况外，临床医生在疑似急性PE的检测选择上意见一致，无论检测前评估的方法或频率如何。
