Brown Morgan L, Quinonez Luis G, Schaff Hartzell V, Sundt Thoralf M
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Ann Thorac Surg. 2008 Dec;86(6):1888-96. doi: 10.1016/j.athoracsur.2008.08.054.
Little information exists on the quality of the data obtained in follow-up surveys in cardiac surgical patients. We designed a questionnaire to capture relevant cardiac surgical outcomes in adult patients and validated it against similar variables in the medical record.
Questionnaires were mailed to 200 consecutive patients who underwent cardiac operations and had a complete cardiovascular consultation more than 1 month after hospital dismissal. The sensitivity and specificity for each question was compared with the electronic medical record.
The median age at operation was 62.5 years (range, 19.6 to 91.1 years). The mean age of responders (n = 149, 75%) was 69 +/- 13 years, and 93% lived independently in their own home. Responders and nonresponders were similar. Sensitivity and specificity of self-reporting (95% confidence intervals) included atrial fibrillation, 74% (60% to 85%) and 94% (87% to 98%); stroke, 89% (52% to 100%) and 97% (93% to 99%); bleeding requiring hospitalization, 57% (18% to 90%) and 96% (92 to 99%); permanent pacemaker implantation, 95% (75% to 100%) and 100% (97% 100%); and coronary stenting, 93% (66% to 100%) and 99% (96% to 100%).
Patients were reasonably accurate in reporting (high specificity) when asked about a medical condition that was not present, but were not always aware of documented medical issues (moderate sensitivity). When asked about procedures, responses were highly sensitive, specific, and accurate. Patients had difficulty discriminating among complex invasive procedures. Clinical investigators must be aware of the limitations of the data obtained from surveys, and positive responses should be confirmed.
关于心脏手术患者随访调查所获数据质量的信息较少。我们设计了一份问卷，用于收集成年患者的相关心脏手术结局，并对照病历中的类似变量对其进行验证。
向200例连续接受心脏手术且出院后1个月以上进行了完整心血管会诊的患者邮寄问卷。将每个问题的敏感性和特异性与电子病历进行比较。
手术时的中位年龄为62.5岁（范围19.6至91.1岁）。应答者（n = 149，75%）的平均年龄为69±13岁，93%的患者独立居住在家中。应答者和未应答者相似。自我报告的敏感性和特异性（95%置信区间）包括房颤，分别为74%（60%至85%）和94%（87%至98%）；中风，分别为89%（52%至100%）和97%（93%至99%）；需要住院治疗的出血，分别为57%（18%至90%）和96%（92%至99%）；永久性起搏器植入，分别为95%（75%至100%）和100%（97%至100%）；以及冠状动脉支架置入，分别为93%（66%至100%）和99%（96%至100%）。
当被问及不存在的医疗状况时，患者报告的准确性较高（特异性高），但并非总是知晓已记录的医疗问题（敏感性中等）。当被问及手术时，回答的敏感性、特异性和准确性都很高。患者难以区分复杂的侵入性手术。临床研究人员必须意识到从调查中获得的数据的局限性，阳性反应应予以确认。
