Farrell T, Mahon T, Daly L, Masterson J
Department of Radiology, St Vincent's Hospital, Dublin, Ireland.
Br J Radiol. 1994 Jan;67(793):32-5. doi: 10.1259/0007-1285-67-793-32.
The objective of this study was to derive and test clinical scoring system in order to predict the presence of gallstones and to identify inappropriate referrals. The design of this scoring system comprised a prospective audit of all referrals with suspected gallstones and a prospective validation of the system on new patients. The subjects used in the study consisted of 300 inpatient, outpatient and general practitioner referrals to a radiology department with suspected gallstones during the period 1984-1986 (1st cohort) and 200 similar referrals from 1987 to 1988 (2nd cohort). The main outcome measures were gallstones as determined by oral cholecystogram and/or ultrasound of the gallbladder. 32.7% and 24.0% of referrals in the first and second cohorts, respectively, had gallstones. A scoring system to predict gallstones was derived on the first cohort based on age, Murphy's sign, duration and type of pain, presence or absence of flatulence, and source of referral. This scoring system discriminated well between those with and without stones in both cohorts. Low risk groups, comprising about 15% of the referrals in each cohort, were identified with a prevalence of gallstones of 4.5% (1st cohort) and 3.0% (2nd cohort). If these patients had not been referred the radiological workload would have dropped by 15%, with a very small reduction in diagnostic yield. We conclude that prior to radiological assessment it is possible, on the basis of source of referral and symptoms, to identify a group of patients with a low prevalence of gallstones. These cases, with a low diagnostic yield, contribute substantially to the workload of a radiological department.
本研究的目的是推导并测试一种临床评分系统，以预测胆结石的存在并识别不适当的转诊。该评分系统的设计包括对所有疑似胆结石转诊病例的前瞻性审核以及在新患者中对该系统进行前瞻性验证。本研究使用的受试者包括1984年至1986年期间（第1组队列）转诊至放射科的300例疑似胆结石的住院患者、门诊患者和全科医生转诊病例，以及1987年至1988年期间的200例类似转诊病例（第2组队列）。主要结局指标是通过口服胆囊造影和/或胆囊超声确定的胆结石。第1组队列和第2组队列中分别有32.7%和24.0%的转诊病例患有胆结石。基于年龄、墨菲氏征、疼痛持续时间和类型、是否存在肠胃胀气以及转诊来源，在第1组队列中推导了一种预测胆结石的评分系统。该评分系统在两个队列中对有结石和无结石的患者区分效果良好。确定了低风险组，每组队列中约15%的转诊病例属于该组，其胆结石患病率分别为4.5%（第1组队列）和3.0%（第2组队列）。如果这些患者未被转诊，放射科的工作量将减少15%，而诊断率的降低幅度非常小。我们得出结论，在进行放射学评估之前，根据转诊来源和症状，有可能识别出一组胆结石患病率较低的患者。这些诊断率较低的病例在很大程度上增加了放射科的工作量。
