Walker M K, Whincup P H, Shaper A G, Lennon L T, Thomson A G
Department of Primary Care and Population Sciences, Royal Free Hospital School of Medicine, London, England.
Am J Epidemiol. 1998 Aug 15;148(4):355-61. doi: 10.1093/oxfordjournals.aje.a009653.
Few studies have assessed the accuracy of patient recall of doctor-diagnosed heart attack and stroke on postal questionnaire, yet such data are widely used in epidemiologic studies. In the national prospective British Regional Heart Study of 7,735 men aged 40-59 years, based in general practice and followed up for a mean 13.8 years, a mailed questionnaire was sent to all available survivors in 1992. Patient recall of doctor-diagnosed heart attack and stroke was compared with the 316 new general practice-reported heart attacks and 102 new general practice-reported strokes from the medical record reviews. Both study and general practice records were checked for all discordant findings, and corrections were made to the study database. Patients tended to overrecall major cardiovascular events more than they underrecalled them, 33% versus 6% for heart attacks and 25% versus 11% for strokes. Among overrecalled heart attacks, other circulatory problems were present in 78% of the subjects; transient ischemic attacks accounted for 57% of overrecalled strokes. In contrast, the general practice record review system tended to underreport events rather than to overreport them, 3% versus 0.3% for heart attacks and 23% versus 5% for strokes. Patient recall of doctor-diagnosed heart attack and stroke provides a useful method for estimating prevalence rates and resource needs, but the tendency to overestimation needs to be recognized. In etiologic studies when strict diagnostic case criteria are essential, patient recall should be used to complement rather than to supplant medical record data.
很少有研究评估患者通过邮寄问卷调查回忆医生诊断的心脏病发作和中风的准确性，然而这些数据在流行病学研究中被广泛使用。在全国性的前瞻性英国地区心脏研究中，对7735名年龄在40 - 59岁的男性进行了研究，该研究以全科医疗为基础，平均随访13.8年。1992年，向所有可联系到的幸存者发送了一份邮寄问卷。将患者回忆的医生诊断的心脏病发作和中风情况与病历审查中316例新的全科医疗报告的心脏病发作和102例新的全科医疗报告的中风情况进行了比较。对所有不一致的结果都检查了研究记录和全科医疗记录，并对研究数据库进行了修正。患者对重大心血管事件的回忆往往是高估多于低估，心脏病发作的高估率为33%，低估率为6%；中风的高估率为25%，低估率为11%。在被高估的心脏病发作中，78%的受试者存在其他循环系统问题；短暂性脑缺血发作占被高估中风病例的57%。相比之下，全科医疗记录审查系统往往漏报事件而非多报事件，心脏病发作的漏报率为3%，多报率为0.3%；中风的漏报率为23%，多报率为5%。患者回忆医生诊断的心脏病发作和中风情况为估计患病率和资源需求提供了一种有用的方法，但需要认识到存在高估的倾向。在病因学研究中，当严格的诊断病例标准至关重要时，患者回忆应作为补充而非替代病历数据。
