Westman E C, Matchar D B, Samsa G P, Mulrow C D, Waugh R A, Feussner J R
Center for Health Services Research in Primary Care, Duke University, Durham, North Carolina 27705, USA.
J Gen Intern Med. 1995 Aug;10(8):455-7. doi: 10.1007/BF02599919.
This study assessed physician performance in detecting the apical S3 gallop using a cardiology patient simulator. Six physicians (two cardiology fellows, two medicine residents, and two attending physicians) performed two sets of 24 cardiac examinations that included the presence or absence of an apical S3 gallop. All the examiners were able to significantly alter the prior odds of an apical S3 gallop's being present, but the cardiology fellows had higher sensitivities. Sensitivity was lower for detecting soft S3 gallops, and specificity was lower when a diastolic murmur was also present. Physician performance in detecting apical S3 gallops is variable, but can be excellent.
本研究使用心脏病患者模拟器评估了医生检测心尖部S3奔马律的表现。六位医生（两名心脏病学研究员、两名内科住院医师和两名主治医师）进行了两组24次心脏检查，检查内容包括心尖部S3奔马律的有无。所有检查者都能够显著改变心尖部S3奔马律存在的先验概率，但心脏病学研究员的敏感性更高。检测柔和的S3奔马律时敏感性较低，同时存在舒张期杂音时特异性较低。医生在心尖部S3奔马律检测方面的表现存在差异，但也可以非常出色。
