地高辛检测服务的使用与滥用
Use and misuse of a digoxin assay service.
作者信息
Gibb I, Cowan J C, Parnham A J, Thomas T H
出版信息
Br Med J (Clin Res Ed). 1986 Sep 13;293(6548):678-80. doi: 10.1136/bmj.293.6548.678.
In a study of the use of a digoxin assay service and its influence on clinical management 285 assay requests were audited over 12 weeks. For 67 (24%) there was no clear clinical indication for the request and for 140 the period between the last dose of digoxin being given and the blood sample being taken was either unknown or inappropriate. Treatment in 64 patients (22%) was changed after the assay result was received [corrected]. 24 of these changes bore no relation to the original clinical indication for requesting the assay, suggesting that such changes were based on the assay result alone. Of samples collected within six hours after the last dose, 15 of 69 (22%) led to a reduction in treatment compared with 10 of 116 (9%) taken after six hours (p less than 0.025), thereby highlighting the danger that incorrectly timed samples may lead to inappropriate clinical decisions.
在一项关于地高辛检测服务的使用及其对临床管理影响的研究中，在12周内对285份检测申请进行了审核。其中67份（24%）申请没有明确的临床指征，140份申请中，从上一次给予地高辛到采集血样之间的时间要么未知，要么不合适。64名患者（22%）在收到检测结果后治疗方案发生了改变[已修正]。其中24项改变与最初申请检测的临床指征无关，这表明此类改变仅仅基于检测结果。在最后一剂药物服用后6小时内采集的样本中，69份中有15份（22%）导致了治疗方案的减少，而6小时后采集的116份样本中有10份（9%）导致治疗方案减少（p<0.025），从而凸显了采样时间不当可能导致不恰当临床决策的风险。
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