Federman D G, Concato J, Caralis P V, Hunkele G E, Kirsner R S
Department of Medicine, Yale University School of Medicine, New Haven, Conn., USA.
Arch Dermatol. 1997 Nov;133(11):1423-5.
To estimate the frequency of recorded screening for skin cancer in primary care settings.
Retrospective observational cohort study.
Two academically affiliated Department of Veterans Affairs Medical Centers.
Two hundred randomly selected patients at least 50 years old and receiving care at outpatient medical clinics.
Frequency of documented skin examinations, in comparison with other tests routinely done as screening, during a 2-year period.
Medical record review to identify how often selected components of the physical examination and specific procedures were documented during ambulatory visits.
Among the 200 subjects, the frequency of documented examinations and procedures included fecal occult blood testing in 120 (60%), rectal examination in 128 (64%), and sigmoidoscopy in 93 (47%), prostate examination was performed in 114 (59%) of 193 men. In contrast, skin examination was documented in only 56 (28%) of 200 subjects (P < .001 for each comparison with other tests). As an estimate of the "true" frequency of screening for skin cancer, 35 (18%) of 165 patients without skin-related complaints had a documented skin examination.
Skin cancer screening is infrequently documented and therefore possibly omitted in the context of primary care visits.
评估基层医疗环境中记录的皮肤癌筛查频率。
回顾性观察队列研究。
两所隶属于学术机构的退伍军人事务部医疗中心。
从门诊医疗诊所中随机选取的200名至少50岁的患者。
在2年期间，记录的皮肤检查频率与作为筛查常规进行的其他检查的频率相比较。
通过病历审查确定在门诊就诊期间体格检查的选定组成部分和特定程序的记录频率。
在200名研究对象中，记录的检查和程序频率包括：120人（60%）进行了粪便潜血试验，128人（64%）进行了直肠检查，93人（47%）进行了乙状结肠镜检查，193名男性中有114人（59%）进行了前列腺检查。相比之下，200名研究对象中只有56人（28%）有皮肤检查记录（与其他检查相比，每次比较P <.001）。作为皮肤癌筛查“真实”频率的估计，165名无皮肤相关主诉的患者中有35人（18%）有记录的皮肤检查。
皮肤癌筛查记录很少，因此在基层医疗就诊时可能被遗漏。
