Strong Mark, Green Angela, Goyder Elizabeth, Miles Gail, Lee Andrew C K, Basran Gurnam, Cooke Jo
School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
Prim Care Respir J. 2014 Mar;23(1):67-73. doi: 10.4104/pcrj.2014.00005.
Studies have suggested that chronic obstructive pulmonary disease (COPD) is commonly misdiagnosed and misclassified in primary care, but less is known about the quality of diagnosis in specialist respiratory care.
To measure the accuracy of COPD diagnosis and classification of airway obstruction in primary care and at a specialist respiratory centre, and to explore associations between misdiagnosis and misclassification and a range of explanatory factors.
Data were obtained for 1,205 referrals to a specialist respiratory centre between 2007 and 2010. Standard analysis methods were used.
The majority of patients were referred for pulmonary rehabilitation (676/1,205, 56%). Of 1,044 patients with a primary care diagnosis of COPD, 211 (20%) had spirometry inconsistent with COPD. In comparison, of 993 specialist centre diagnoses, 65 (6.5%) had inconsistent spirometry. There was poor agreement between the airflow obstruction grade recorded on the referral and that based on spirometry (kappa=0.26, n=448), whereas agreement between the respiratory centre assessment of airflow obstruction and spirometry was good (kappa=0.88, n=1,016). Referral by practice nurse was associated with accuracy of airflow obstruction classification in primary care (OR 1.85, 95% CI 1.33 to 2.57). Males were more likely than females to have an accurate specialist care classification of airway obstruction (OR 1.40, 95% CI 1.01 to 1.93). Grade of airway obstruction changed between referral and assessment in 56% of cases.
In primary care, a proportion of patients diagnosed with COPD do not have COPD, and misclassification of grade of airflow obstruction is common. Misdiagnosis and misclassification is less common in the specialist care setting of BreathingSpace.
研究表明，慢性阻塞性肺疾病（COPD）在初级保健中常被误诊和错误分类，但对于专科呼吸护理中的诊断质量了解较少。
测量初级保健和专科呼吸中心对COPD的诊断准确性以及气道阻塞的分类情况，并探讨误诊和错误分类与一系列解释因素之间的关联。
获取了2007年至2010年间转诊至专科呼吸中心的1205例患者的数据。采用标准分析方法。
大多数患者被转诊进行肺康复（676/1205，56%）。在1044例初级保健诊断为COPD的患者中，211例（20%）的肺功能测定结果与COPD不符。相比之下，在993例专科中心诊断中，65例（6.5%）的肺功能测定结果不一致。转诊时记录的气流阻塞分级与基于肺功能测定的分级之间一致性较差（kappa = 0.26，n = 448），而呼吸中心对气流阻塞的评估与肺功能测定之间的一致性良好（kappa = 0.88，n = 1016）。由执业护士转诊与初级保健中气流阻塞分类的准确性相关（比值比1.85，95%可信区间1.33至2.57）。男性比女性更有可能在专科护理中获得准确的气道阻塞分类（比值比1.40，95%可信区间1.01至1.93）。在56%的病例中，转诊和评估之间的气道阻塞分级发生了变化。
在初级保健中，一部分被诊断为COPD的患者实际上并非COPD，气流阻塞分级的错误分类很常见。在BreathingSpace专科护理环境中，误诊和错误分类较少见。
