Hedges J R, Singal B M, Estep J L
Oregon Health Sciences University, Division of Emergency Medicine, Portland 97201-3098.
Med Decis Making. 1991 Apr-Jun;11(2):119-24. doi: 10.1177/0272989X9101100209.
The impact of a rapid streptococcal screening test (RSS) on clinical decision making in the management of patients with acute pharyngitis was evaluated. Physicians managing 95 ambulatory patients with the complaint of sore throat were asked to estimate the probability of group A beta-hemolytic streptococcal pharyngitis (GRABS) in each patient and whether they intended to treat with antibiotics both before and after the results of the RSS were known. Simultaneous throat cultures were obtained for 80 patients at the discretion of the treating physicians. Regression analysis revealed that the RSS result was an important independent predictor for the posttest decision to treat with antibiotics and for the estimated probability of disease. The mean absolute log-likelihood ratio was used to quantify the effect of the RSS on diagnostic certainty; a greater contribution to diagnostic certainty occurred when the RSS was positive. Physicians would have prescribed an antibiotic 49 times without the benefit of the RSS and prescribed an antibiotic 48 times given the RSS result. Without the RSS, the treatment decision contradicted the throat culture result in 25 cases. With the RSS, this occurred in 26 cases. The RSS, while influencing decision making, especially when positive, did not decrease the use of antibiotics.
评估了快速链球菌筛查试验（RSS）对急性咽炎患者管理中临床决策的影响。要求负责管理95例主诉咽痛的门诊患者的医生，在知晓RSS结果之前和之后，分别估计每位患者患A组β溶血性链球菌咽炎（GRABS）的概率以及他们是否打算使用抗生素进行治疗。根据主治医生的判断，为80例患者同时进行了咽拭子培养。回归分析显示，RSS结果是抗生素治疗后决策以及疾病估计概率的重要独立预测因素。使用平均绝对对数似然比来量化RSS对诊断确定性的影响；当RSS呈阳性时，对诊断确定性的贡献更大。在没有RSS结果的情况下，医生会开具49次抗生素，而根据RSS结果则开具48次抗生素。在没有RSS的情况下，治疗决策与咽拭子培养结果在25例中出现矛盾。有了RSS后，这种情况发生了26例。RSS虽然影响决策，尤其是在呈阳性时，但并没有减少抗生素的使用。
