Spiteri M A, Cook D G, Clarke S W
Department of Thoracic Medicine, Royal Free Hospital, London.
Lancet. 1988 Apr 16;1(8590):873-5. doi: 10.1016/s0140-6736(88)91613-3.
Agreement between 24 physicians on the presence or absence of respiratory signs was investigated. The physicians were divided into six sets of 4; each set examined 4 patients with well-defined chest signs. There was generally poor agreement about particular signs. Overall, the 4 physicians in a set were in complete agreement only 55% of the time. Some signs such as wheezing seemed to be more reliably elicited than others such as whispering pectoriloquy. Comparison of diagnoses based on the clinical findings with the correct diagnoses supported by investigations showed that 28% of physicians' diagnoses were incorrect. The more often the examiners differed from the majority on the presence or absence of a sign, the more likely they were to make an incorrect diagnosis. A ranked order of the reliability with which chest signs are elicited would improve the teaching of chest medicine.
对24位医生在呼吸体征存在与否方面的一致性进行了调查。医生们被分成6组，每组4人；每组检查4名有明确胸部体征的患者。对于特定体征，总体上一致性较差。总体而言，一组中的4位医生只有55%的时间完全一致。有些体征，如哮鸣音，似乎比其他体征，如胸语音，更能可靠地引出。将基于临床发现的诊断与经检查证实的正确诊断进行比较，结果显示28%的医生诊断有误。检查者在体征存在与否方面与大多数人意见分歧越频繁，他们做出错误诊断的可能性就越大。对引出胸部体征的可靠性进行排序将有助于胸部医学的教学。
