Mann J, Holdstock G, Harman M, Machin D, Loehry C A
Br Med J (Clin Res Ed). 1983 Oct 1;287(6397):937-40. doi: 10.1136/bmj.287.6397.937.
The introduction of an open access general practitioner endoscopy service may result in many unnecessary examinations being performed. In an attempt to prevent this, 235 patients attending for endoscopy were interviewed and the results analysed to determine which factors best discriminated between those with major disease (ulcers, cancers, oesophageal strictures; n = 48) and those without (n = 187). The six characteristics which best discriminated between the two groups were increasing age, history of vomiting, male sex, smoking, and a past history of peptic ulcer or hiatus hernia. With the use of these six features a scoring system was devised, designed to give an indication of the likelihood of finding such disease in an individual patient. This was assessed prospectively in a further 356 patients. The results showed that by utilising this scoring system it would be possible to reduce the number of examinations performed by 30% yet still detect 98% of serious disease. If confirmed in further prospective studies, this scoring system (or a modification) could more accurately assess individual priority for endoscopy and enable optimum use to be made of limited resources.
引入开放获取的全科医生内镜检查服务可能会导致进行许多不必要的检查。为了防止这种情况发生，对235名接受内镜检查的患者进行了访谈，并对结果进行分析，以确定哪些因素最能区分患有重大疾病（溃疡、癌症、食管狭窄；n = 48）和未患重大疾病（n = 187）的患者。最能区分两组患者的六个特征是年龄增长、呕吐史、男性、吸烟以及消化性溃疡或食管裂孔疝病史。利用这六个特征设计了一个评分系统，旨在表明在个体患者中发现此类疾病的可能性。在另外356名患者中对其进行了前瞻性评估。结果表明，通过使用该评分系统，可以将检查数量减少30%，但仍能检测出98%的严重疾病。如果在进一步的前瞻性研究中得到证实，这个评分系统（或其改进版本）可以更准确地评估个体进行内镜检查的优先级，并使有限的资源得到最佳利用。
