Kline Jeffrey A, Neumann Dawn, Raad Samih, Schriger David L, Hall Cassandra L, Capito Jake, Kammer David
J.A. Kline is professor and vice chair of research, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana. D. Neumann is assistant professor, Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana. S. Raad is resident, Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana. D.L. Schriger is professor and vice chair, Department of Emergency Medicine, University of California, Los Angeles, Los Angeles, California. C.L. Hall is research manager, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana. J. Capito is resident, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana. D. Kammer is clinical associate professor, Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Acad Med. 2017 Nov;92(11):1607-1616. doi: 10.1097/ACM.0000000000001674.
The authors hypothesize patient facial affect may influence clinician pretest probability (PTP) estimate of cardiopulmonary emergency (CPE) and desire to order a computerized tomographic pulmonary angiogram (CTPA).
This prospective study was conducted at three Indiana University-affiliated hospitals in two parts: collecting videos of patients undergoing CTPA for suspected acute pulmonary embolism watching a humorous video (August 2014-April 2015) and presenting the medical histories and videos to clinicians to determine the impact of patient facial affect on physicians' PTP estimate of CPE and desire to order a CTPA (June-November 2015). Patient outcomes were adjudicated as CPE+ or CPE- by three independent reviewers. Physicians completed a standardized test of facial affect recognition, read standardized medical histories, then viewed videos of the patients' faces. Clinicians marked their PTP estimate of CPE and desire for a CTPA before and after seeing the video on a visual analog scale (VAS).
Fifty physicians completed all 73 videos. Seeing the patient's face produced a > 10% absolute change in PTP estimate of CPE in 1,204/3,650 (33%) cases and desire for a CTPA in 1,095/3,650 (30%) cases. The mean area under the receiver operating characteristic curve for CPE estimate was 0.55 ± 0.15, and the change in CPE VAS was negatively correlated with physicians' standardized test scores (r = -0.23).
Clinicians may use patients' faces to make clinically important inferences about presence of serious illness and need for diagnostic testing. However, these inferences may fail to align with actual patient outcomes.
作者推测患者的面部表情可能会影响临床医生对心肺急症（CPE）的预检概率（PTP）估计以及开具计算机断层扫描肺动脉造影（CTPA）的意愿。
这项前瞻性研究在印第安纳大学附属的三家医院分两部分进行：收集疑似急性肺栓塞患者接受CTPA检查时观看幽默视频的视频（2014年8月至2015年4月），并将患者病史和视频呈现给临床医生，以确定患者面部表情对医生CPE的PTP估计以及开具CTPA意愿的影响（2015年6月至11月）。由三名独立评审员将患者结局判定为CPE阳性或CPE阴性。医生完成面部表情识别标准化测试，阅读标准化病史，然后观看患者面部视频。临床医生在观看视频前后，通过视觉模拟量表（VAS）标记他们对CPE的PTP估计以及对CTPA的需求。
50名医生看完了所有73个视频。在3650例病例中，有1204例（33%）看到患者面部后CPE的PTP估计出现了>10%的绝对变化，在3650例病例中有1095例（30%）对CTPA的需求出现了变化。CPE估计的受试者操作特征曲线下的平均面积为0.55±0.15，CPE视觉模拟量表的变化与医生的标准化测试分数呈负相关（r = -0.23）。
临床医生可能会利用患者的面部表情对严重疾病的存在和诊断测试的需求做出重要的临床推断。然而，这些推断可能与患者的实际结局不一致。
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