Lopes J R, Oliveira A C, Rios V G, Correia L C L
Escola Bahiana de Medicina e Saúde Pública, Brotas, Salvador, BA, Brasil.
Cardioclin, Conceição do Coité, BA, Brasil.
Braz J Med Biol Res. 2018;51(8):e7413. doi: 10.1590/1414-431x20187413. Epub 2018 May 28.
Complementary examinations are "inadequate" whenever the likelihood of benefits from their indication is lower than the negative results. The low benefit is a result of poor performance in detecting relevant changes that lead to improved behavior. However, inadequate examinations are prevalent and little is known about patients' notions of the usefulness of such indications. The aim of this study was to describe relevant findings in inappropriate echocardiograms and to assess the level of agreement between patients and cardiologists regarding their usefulness. Adults without known cardiovascular disease who were referred for echocardiogram by inappropriate criteria according to the American College of Cardiology were selected. Relevant findings were defined by any change in the degree of moderate to severe, according to the American Society of Echocardiography. We tested the level of agreement between the patients who underwent echocardiographic examination and the physicians who requested the exam through a standard questionnaire. Five hundred patients were included, with average age of 52±17 years (47% males). Only 17 patients had any relevant changes (3.4%, 95%CI=2 to 5.4%). The most frequent alterations included valve changes in 8 and diastolic dysfunction grade II in 6 patients. Eighty-seven examinations were performed to determine the level of agreement between patients and cardiologists. For the question "Is this test really necessary?", 92% of patients responded positively, compared with 5% of cardiologists (Kappa negative 0.04; P=0.01). The frequency of relevant findings was low in inadequate echocardiograms and patients and cardiologists had a different perception regarding its usefulness.
只要补充检查从其指征中获益的可能性低于阴性结果，那么这些检查就是“不充分的”。获益低是由于在检测导致行为改善的相关变化方面表现不佳。然而，不充分的检查很普遍，而且对于患者对这些指征有用性的看法知之甚少。本研究的目的是描述不适当超声心动图检查中的相关发现，并评估患者和心脏病专家在其有用性方面的一致程度。根据美国心脏病学会的标准，选择了因不适当标准而被转诊进行超声心动图检查的无已知心血管疾病的成年人。根据美国超声心动图学会的标准，相关发现定义为中度至重度程度的任何变化。我们通过一份标准问卷测试了接受超声心动图检查的患者与要求进行该检查的医生之间的一致程度。纳入了500名患者，平均年龄为52±17岁（47%为男性）。只有17名患者有任何相关变化（3.4%，95%CI=2%至5.4%）。最常见的改变包括8例瓣膜改变和6例舒张功能障碍二级。进行了87次检查以确定患者和心脏病专家之间的一致程度。对于“这项检查真的有必要吗？”这个问题，92%的患者回答是肯定的，而心脏病专家的这一比例为5%（卡帕值为-0.04；P=0.01）。在不充分的超声心动图检查中，相关发现的频率较低，患者和心脏病专家对其有用性的看法不同。
