临床实践中三级医疗中心偶然发现的负担。

The burden of incidental findings in clinical practice in a tertiary care center.

机构信息

2nd Department of Medicine, University of Athens Medical School, Hippokration General Hospital, Athens, Greece.

出版信息

Eur J Intern Med. 2010 Apr;21(2):123-6. doi: 10.1016/j.ejim.2009.12.012. Epub 2010 Jan 27.

DOI:10.1016/j.ejim.2009.12.012

PMID:20206884

Abstract

BACKGROUND

To evaluate the prevalence and clinical burden of serendipitously discovered abnormalities in hospitalized patients, unrelated to their presenting symptoms and physical signs.

METHODS

A total of 478 patients consecutively admitted in the Department of Medicine were enrolled in the study. In the end of first diagnostic work-up, the previously undetected imaging or endoscopic asymptomatic abnormalities termed as incidental findings (IFs) were recorded and some of them were further investigated.

RESULTS

One hundred thirty eight (28.8%) patients had IFs. The most common IFs were located in the kidney and genitourinary system followed by liver and gallbladder. The most common method of detection of IFs was ultrasonography (US) of the abdomen. The patients with IFs compared with those without, were older (P=0.007), had no previous hospitalizations (P<0.001) and stayed longer in the hospital (P<0.001). The 25 (18.1%) patients with IFs were not evaluated further. One hundred seventy seven IFs discovered in 113 patients were further evaluated by medical specialists and additional tests were performed if warranted. In the end of the diagnostic work-up, in a total of 113 patients with IFs, 78.7% had insignificant and 21.2% potentially significant IFs. The latter group had higher rate of IFs compared with the former group, usually more than 3 (P=0.017).

CONCLUSIONS

IFs were prevalent in a hospital population. Hospitalized patients with IFs were more than 60 years old and had no previous hospitalization. A large number of IFs were potentially significant deserving further clinical management.

摘要

背景

评估住院患者中与就诊症状和体征无关的偶然发现的异常的流行率和临床负担。

方法

共纳入 478 例连续收入内科的患者。在首次诊断性检查结束时，记录先前未检测到的影像学或内镜无症状异常，称为偶然发现（IFs），并对其中一些进行了进一步检查。

结果

138 例（28.8%）患者存在 IFs。最常见的 IFs 位于肾脏和泌尿生殖系统，其次是肝脏和胆囊。IFs 最常见的检测方法是腹部超声（US）。与无 IFs 的患者相比，IFs 患者年龄更大（P=0.007），无既往住院史（P<0.001）且住院时间更长（P<0.001）。25 例（18.1%）IFs 患者未进一步评估。113 例患者的 177 个 IFs 由医学专家进一步评估，如果需要，进行了额外的检查。在诊断性检查结束时，在总共 113 例存在 IFs 的患者中，78.7%的 IFs 无临床意义，21.2%的 IFs 可能具有临床意义。后者组的 IFs 发生率高于前者组，通常超过 3 个（P=0.017）。