格雷夫斯病诊断之路上的弯路
Detours on the road to diagnosis of Graves disease.
作者信息
Sims Emily K, Eugster Erica A, Nebesio Todd D
机构信息
Riley Hospital for Children, Indianapolis, IN 46202, USA.
出版信息
Clin Pediatr (Phila). 2012 Feb;51(2):160-4. doi: 10.1177/0009922811418823. Epub 2011 Aug 25.
OBJECTIVES
The aims of this study were to determine the frequency at which spurious diagnoses and unnecessary treatment occurs prior to the diagnosis of Graves disease (GD) and to evaluate the economic consequences of these events.
METHODS
Retrospective chart review of children diagnosed with GD.
RESULTS
A total of 76 children (61 girls) aged 11.9 ± 3.8 years were identified. In all, 17 (22.4%) were referred to other subspecialists prior to diagnosis of GD. Six were hospitalized, and 2 visited emergency rooms. A total of 15 (19.7%) underwent nonthyroid-related studies. Estimated cost of testing and procedures ranged from $49 to $14,000. Twelve (15.8%) were diagnosed with attention deficit/hyperactivity disorder, and 16 (21.1%) were started on medications for other conditions prior to diagnosis of GD.
CONCLUSIONS
Evaluation and treatment for presumed other disorders are common in children with GD. A high index of suspicion for hyperthyroidism by primary care providers may help to avoid clinical detours that may be costly and delay diagnosis.
目的
本研究旨在确定在格雷夫斯病（GD）诊断之前出现假性诊断和不必要治疗的频率，并评估这些事件的经济后果。
方法
对诊断为GD的儿童进行回顾性病历审查。
结果
共确定了76名年龄为11.9±3.8岁的儿童（61名女孩）。总共有17名（22.4%）在GD诊断之前被转诊至其他专科医生处。6名住院，2名去过急诊室。共有15名（19.7%）接受了非甲状腺相关检查。检测和程序的估计费用从49美元到14,000美元不等。12名（15.8%）被诊断为注意力缺陷/多动障碍，16名（21.1%）在GD诊断之前开始接受其他疾病的药物治疗。
结论
对疑似其他疾病的评估和治疗在GD儿童中很常见。初级保健提供者对甲状腺功能亢进保持高度怀疑指数可能有助于避免可能代价高昂且延迟诊断的临床弯路。
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