Centre for Population Health Sciences, University of Edinburgh, Edinburgh, Scotland.
JAMA Intern Med. 2013 Mar 25;173(6):407-16. doi: 10.1001/jamainternmed.2013.2762.
Diagnostic tests are often ordered by physicians in patients with a low pretest probability of disease to rule out conditions and reassure the patient.
To study the effect of diagnostic tests on worry about illness, anxiety, symptom persistence, and subsequent use of health care resources in patients with a low pretest probability of serious illness.
Systematic review and meta-analysis. We searched MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, PsychINFO, CINAHL, and ProQuest Dissertations electronic databases through December 31, 2011, for eligible randomized controlled trials. We independently identified studies for inclusion and extracted the data. Disagreements were resolved by discussion. We performed meta-analysis if heterogeneity was low or moderate (I2 < 50%).
Fourteen randomized controlled trials that included 3828 patients met the inclusion criteria and were analyzed with outcomes categorized as short term (≤3 months) or long term (>3 months). Three trials showed no overall effect of diagnostic tests on illness worry (odds ratio, 0.87 [95% CI, 0.55-1.39]), and 2 showed no effect on nonspecific anxiety (standardized mean difference, 0.06 [-0.16 to 0.28]). Ten trials showed no overall long-term effect on symptom persistence (odds ratio, 0.99 [95% CI, 0.85-1.15]). Eleven trials measured subsequent primary care visits. We observed a high level of heterogeneity among trials (I2 = 80%). Meta-analysis after exclusion of outliers suggested a small reduction in visits after investigation (odds ratio, 0.77 [95% CI, 0.62-0.96]).
Diagnostic tests for symptoms with a low risk of serious illness do little to reassure patients, decrease their anxiety, or resolve their symptoms, although the tests may reduce further primary care visits. Further research is needed to maximize reassurance from medically necessary tests and to develop safe strategies for managing patients without testing when an abnormal result is unlikely.
医生经常在低疾病先验概率的患者中开诊断性检查，以排除病症并让患者安心。
研究诊断性检查对低重病先验概率患者的疾病担忧、焦虑、症状持续存在以及随后对卫生保健资源的利用的影响。
系统综述和荟萃分析。我们通过 MEDLINE、Cochrane 对照试验中心注册库、EMBASE、PsychINFO、CINAHL 和 ProQuest Dissertations 电子数据库检索，截至 2011 年 12 月 31 日，以确定符合条件的随机对照试验。我们独立确定纳入研究并提取数据。通过讨论解决分歧。如果异质性低或中度（I2 < 50%），我们进行荟萃分析。
符合纳入标准的 14 项随机对照试验共纳入 3828 例患者，根据短期（≤3 个月）或长期（>3 个月）的结局进行分类。三项试验显示诊断性检查对疾病担忧无总体影响（比值比，0.87 [95%CI，0.55-1.39]），两项试验显示对非特异性焦虑无影响（标准化均数差，0.06 [-0.16 至 0.28]）。十项试验显示对症状持续存在无总体长期影响（比值比，0.99 [95%CI，0.85-1.15]）。十一项试验测量了随后的初级保健就诊情况。我们观察到试验之间存在高度异质性（I2 = 80%）。剔除离群值后进行荟萃分析提示，检查后就诊次数略有减少（比值比，0.77 [95%CI，0.62-0.96]）。
对低危严重疾病症状的诊断性检查对缓解患者的担忧、降低焦虑或解决症状几乎没有作用，尽管这些检查可能会减少进一步的初级保健就诊。需要进一步研究，以最大限度地从医学上有必要的检查中获得安心，并制定在不太可能出现异常结果时安全管理不接受检查的患者的策略。
