Sussman E J, Tsiaras W G, Soper K A
JAMA. 1982 Jun 18;247(23):3231-4.
The correct diagnosis of proliferation diabetic retinopathy is essential, because it is a treatable disease and missing the diagnosis can lead to the patient becoming blind. We examined the ability of internists and ophthalmologists to diagnose proliferative retinopathy under optimal conditions. Twenty-three physicians performed retinal examinations on ten diabetic patients and one normal patient with dilated pupils. Physician examiners were members of a university medical center and included 10 internists, 2 diabetologists, 4 senior medical residents, 4 general ophthalmologists, and 3 ophthalmologists who were subspecialists in retinal disease. Correct diagnosis was determined separately by the consensus of three ophthalmologists specializing in retinal disease, who reviewed seven-view stereo fundus photographs and medical charts. Of a possible 483 individual eye a examinations, 438 were completed. The overall error rate was 61%. The error rate for missing the diagnosis of proliferative retinopathy varied from 0% for retinal specialists to 49% for internists, diabetologists, and medical residents. We conclude that potentially serious mistakes in diagnosis are currently made by the physicians who care for most diabetic patients. Experience and specialized knowledge lessen that the error rate. Further education or greater use of referrals may be necessary to provide optimal patient care.
增殖性糖尿病视网膜病变的正确诊断至关重要，因为这是一种可治疗的疾病，漏诊会导致患者失明。我们研究了内科医生和眼科医生在最佳条件下诊断增殖性视网膜病变的能力。23名医生对10名糖尿病患者和1名瞳孔散大的正常患者进行了视网膜检查。医生检查人员来自一所大学医学中心，包括10名内科医生、2名糖尿病专家、4名高级住院医师、4名普通眼科医生以及3名视网膜疾病专科眼科医生。由3名视网膜疾病专科眼科医生通过审查七视图立体眼底照片和病历共同确定正确诊断。在可能的483次单眼检查中，完成了438次。总体错误率为61%。漏诊增殖性视网膜病变的错误率从视网膜专科医生的0%到内科医生、糖尿病专家和住院医师的49%不等。我们得出结论，目前大多数照顾糖尿病患者的医生在诊断中可能会犯严重错误。经验和专业知识可降低错误率。可能需要进一步教育或更多地进行转诊以提供最佳的患者护理。
