咽痛管理中的合理决策：一项快速检测的评估
Rational decisions in managing sore throat: evaluation of a rapid test.
作者信息
Burke P, Bain J, Lowes A, Athersuch R
机构信息
Department of Primary Medical Care, University of Southampton, Aldermoor Health Centre.
出版信息
Br Med J (Clin Res Ed). 1988 Jun 11;296(6637):1646-9. doi: 10.1136/bmj.296.6637.1646.
Sixty nine general practitioners recorded what they had prescribed for a total of 1189 episodes of sore throat. Antibiotics were prescribed in 763 (64%) episodes and broad spectrum antibiotics in 161 (21%) of these. If there was dysphagia, hoarseness, cervical adenopathy, and inflamed or purulent tonsils a prescription was more likely to be written. An enzyme immunoassay rapid test was evaluated as a means of rationalizing prescribing. Among 23 general practitioners and 250 patients the sensitivity of the test was 63% and the specificity 91.7% compared with 74% and 58% for clinical assessment alone. Test results rarely caused previous prescribing decisions (34 [corrected] (13%) episodes) to be altered. We suggest that the time is not ripe for the use of the enzyme immunoassay rapid test on a wide scale in the routine assessment of sore throats.
69名全科医生记录了他们针对总共1189例咽喉痛病例所开具的处方。763例（64%）病例开具了抗生素，其中161例（21%）开具了广谱抗生素。若存在吞咽困难、声音嘶哑、颈部淋巴结病以及扁桃体发炎或化脓，则更有可能开具处方。一种酶免疫分析快速检测法被评估为使处方合理化的一种手段。在23名全科医生和250名患者中，该检测的敏感性为63%，特异性为91.7%，而单纯临床评估的敏感性和特异性分别为74%和58%。检测结果很少导致之前的处方决定（34例（校正后）（13%）病例）被更改。我们认为，在咽喉痛的常规评估中广泛使用酶免疫分析快速检测法的时机尚不成熟。
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