Schols Angel M R, Stakenborg Jacqueline P G, Dinant Geert-Jan, Willemsen Robert T A, Cals Jochen W L
Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.
Fam Pract. 2018 Jan 16;35(1):4-12. doi: 10.1093/fampra/cmx066.
Point-of-care tests (POCT) can assist general practitioners (GPs) in diagnosing and treating patients with acute cardiopulmonary symptoms, but it is currently unknown if POCT impact relevant clinical outcomes in these patients.
To assess whether using POCT in primary care patients with acute cardiopulmonary symptoms leads to more accurate diagnosis and impacts clinical management.
We performed a systematic review in four bibliographic databases. Articles published before February 2016 were screened by two reviewers. Studies evaluating the effect of GP use of POCT on clinical diagnostic accuracy and/or effect on treatment and referral rate in patients with cardiopulmonary symptoms were included.
Our search yielded nine papers describing data from seven studies, on the clinical diagnostic accuracy of POCT in a total of 2277 primary care patients with acute cardiopulmonary symptoms. Four papers showed data on GP use of D-dimer POCT in pulmonary embolism (two studies); two studies on Troponin T in acute coronary syndrome; one on heart-type fatty acid-binding protein (H-FABP) in acute coronary syndrome; one on B-type natriuretic peptide (BNP) in heart failure; one on 3-in-1 POCT (Troponin T, BNP, D-dimer) in acute coronary syndrome, heart failure and/or pulmonary embolism. Only one study assessed the effect of GP use of POCT on treatment initiation and one on actual referral rates.
There is currently limited and inconclusive evidence that actual GP use of POCT in primary care patients with acute cardiopulmonary symptoms leads to more accurate diagnosis and affects clinical management. However, some studies show promising results, especially when a POCT is combined with a clinical decision rule.
即时检验（POCT）有助于全科医生（GP）诊断和治疗急性心肺症状患者，但目前尚不清楚POCT是否会影响这些患者的相关临床结局。
评估在患有急性心肺症状的初级保健患者中使用POCT是否能带来更准确的诊断并影响临床管理。
我们在四个文献数据库中进行了系统评价。两名评审员筛选了2016年2月之前发表的文章。纳入评估全科医生使用POCT对临床诊断准确性和/或对心肺症状患者治疗及转诊率影响的研究。
我们的检索得到9篇描述7项研究数据的论文，涉及2277例患有急性心肺症状的初级保健患者中POCT的临床诊断准确性。4篇论文展示了全科医生在肺栓塞中使用D-二聚体POCT的数据（两项研究）；两项关于急性冠状动脉综合征中肌钙蛋白T的研究；一项关于急性冠状动脉综合征中心型脂肪酸结合蛋白（H-FABP）的研究；一项关于心力衰竭中B型利钠肽（BNP）的研究；一项关于急性冠状动脉综合征、心力衰竭和/或肺栓塞中三合一POCT（肌钙蛋白T、BNP、D-二聚体）的研究。只有一项研究评估了全科医生使用POCT对治疗启动的影响，一项评估了对实际转诊率的影响。
目前有限且不确定的证据表明，全科医生在患有急性心肺症状的初级保健患者中实际使用POCT能带来更准确的诊断并影响临床管理。然而，一些研究显示出有前景的结果，特别是当POCT与临床决策规则相结合时。
