Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, The Netherlands; Department of Psychiatry, Radboud University Nijmegen Medical Centre, The Netherlands.
Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, The Netherlands; Department of Psychiatry, Radboud University Nijmegen Medical Centre, The Netherlands.
Patient Educ Couns. 2012 Jan;86(1):3-8. doi: 10.1016/j.pec.2011.02.003. Epub 2011 Mar 6.
This review is a narrative synthesis of the RCTs which studied the efficacy of using diagnostic tests to reassure patients.
We searched for RCTs that examined the level of reassurance after diagnostic testing in outpatients. We used PubMed, Psychinfo, Cochrane Central, Ongoing Trials Database and Scopus.
We found 5 randomized controlled trials that included 1544 patients. The trials used different diagnostic tests (ECG, radiography of lumbar spine, MR brain scan, laboratory tests, MR of lumbar spine) for different complaints (e.g. chest pain, low back pain and headache). Four out of 5 RCTs did not find a significant reassuring value of the diagnostic tests. One study reported a reassuring effect at 3 months which had disappeared after one year.
Despite the sparse and heterogeneous studies, the results point in the direction of diagnostic tests making hardly any contribution to the level of reassurance. We recommend further studies on the use of diagnostic tests and other strategies to reassure the patient.
A clear explanation and watchful waiting can make additional diagnostic testing unnecessary. If diagnostic tests are used, it is important to provide adequate pre-test information about normal test results.
本综述是对使用诊断性检查来使患者安心的随机对照试验的叙述性综合分析。
我们检索了门诊患者接受诊断性检查后获得的安抚程度的随机对照试验。我们使用了 PubMed、Psychinfo、Cochrane 中心、正在进行的试验数据库和 Scopus。
我们发现了 5 项随机对照试验，共纳入了 1544 名患者。这些试验使用了不同的诊断性检查（心电图、腰椎 X 线、脑部磁共振扫描、实验室检查、腰椎磁共振）来检查不同的症状（如胸痛、腰痛和头痛）。5 项 RCT 中有 4 项没有发现诊断性检查具有显著的安抚价值。一项研究报告称，在 3 个月时有安抚作用，但在 1 年后就消失了。
尽管研究数量稀少且存在异质性，但结果表明诊断性检查对安抚程度几乎没有任何贡献。我们建议进一步研究使用诊断性检查和其他策略来安抚患者。
明确的解释和密切观察等待可以使额外的诊断性检查变得不必要。如果使用诊断性检查，提供关于正常检查结果的充分的预测试信息很重要。
