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ACR 适宜性标准® 慢性咳嗽。

ACR Appropriateness Criteria® Chronic Cough.

机构信息

Naval Medical Center Portsmouth, Portsmouth, Virginia.

Hampton VA Medical Center, Hampton, Virginia.

出版信息

J Am Coll Radiol. 2021 Nov;18(11S):S305-S319. doi: 10.1016/j.jacr.2021.08.007.

Abstract

Chronic cough is defined by a duration lasting at least 8 weeks. The most common causes of chronic cough include smoking-related lung disease, upper airway cough syndrome, asthma, gastroesophageal reflux disease, and nonasthmatic eosinophilic bronchitis. The etiology of chronic cough in some patients may be difficult to localize to an isolated source and is often multifactorial. The complex pathophysiology, clinical presentation, and variable manifestations of chronic cough underscore the challenges faced by clinicians in the evaluation and management of these patients. Imaging plays a role in the initial evaluation, although there is a lack of high-quality evidence guiding which modalities are useful and at what point in time the clinical evaluation should be performed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

摘要

慢性咳嗽定义为持续时间至少 8 周。慢性咳嗽最常见的原因包括与吸烟有关的肺部疾病、上气道咳嗽综合征、哮喘、胃食管反流病和非哮喘性嗜酸性粒细胞性支气管炎。一些患者慢性咳嗽的病因可能难以定位到孤立的来源,通常是多因素的。慢性咳嗽的复杂病理生理学、临床表现和不同表现突出了临床医生在评估和管理这些患者时所面临的挑战。影像学在初始评估中发挥作用,尽管缺乏高质量的证据来指导哪些方式有用,以及在临床评估中应在何时进行。美国放射学院适宜性标准是针对特定临床情况的循证指南,每年由多学科专家小组进行审查。指南的制定和修订包括对同行评议期刊上的现有医学文献进行广泛分析,并应用成熟的方法(RAND/UCLA 适宜性方法和推荐评估、制定和评估分级或 GRADE)来评估特定临床情况下影像学和治疗程序的适宜性。在缺乏证据或证据不确定的情况下,专家意见可以补充现有证据,以推荐影像学或治疗。

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