门诊急性腹痛成人严重疾病的体征和症状:系统综述。

IF 2.5 Q2 PRIMARY HEALTH CARE
BJGP Open Pub Date : 2024-10-29 Print Date: 2024-10-01 DOI:10.3399/BJGPO.2023.0245
Anouk Tans, Thomas Struyf, Rune Geboers, Toon Smeets, Yorick Asselbergh, Emmanuel Declerck, Luca Bloemen, Ann van den Bruel
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引用次数: 0

摘要

背景:急性腹痛是一种常见的主诉,由多种疾病引起,从危及生命的急性病到良性和自限性疾病,症状重叠使诊断复杂化。在评估患者时,体征和症状可能对指导临床工作很有价值。目的:总结在非住院治疗环境中,体征和症状对成人急性腹痛重症诊断准确性的证据:我们进行了一项系统性综述,搜索前瞻性诊断准确性研究,研究对象包括在非住院医疗机构就诊的急性腹痛成人:采用综合检索策略,检索了六个数据库和指南登记册。我们评估了偏倚风险,计算了描述性统计数据和诊断准确性指标。在至少有四项研究可用的情况下,我们对结果进行了汇总:在 18,923 项独特的研究中,我们纳入了 16 项存在中度至高度偏倚风险的研究。有 14 项临床特征符合我们的标准,包括收缩压 0.85、子宫颈运动触痛(LR +5.62 和 LR- 8.60)和自我评估问卷得分大于 70(LR +12.20)或结论:我们确定了 14 种可影响严重疾病可能性的体征和症状,包括疼痛特征、全身体征、妇科体征和临床医生的总体评估。偏倚风险为中度至高度,导致不确定性,使我们无法做出肯定的结论。这凸显了在这种情况下进行更好研究的必要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Signs and symptoms of serious illness in adults with acute abdominal pain presenting to ambulatory care: a systematic review.

Background: Acute abdominal pain is a common complaint, caused by a variety of conditions, ranging from acutely life-threatening to benign and self-limiting, with symptom overlap complicating diagnosis. Signs and symptoms may be valuable when assessing a patient to guide clinical work.

Aim: Summarising evidence on the accuracy of signs and symptoms for diagnosing serious illness in adults with acute abdominal pain in an ambulatory care setting.

Design & setting: We performed a systematic review, searching for prospective diagnostic accuracy studies that included adults presenting with acute abdominal pain to an ambulatory care setting.

Method: Six databases and guideline registers were searched, using a comprehensive search strategy. We assessed the risk of bias, and calculated descriptive statistics and measures of diagnostic accuracy. Results were pooled when at least four studies were available.

Results: Out of 18 923 unique studies, 16 studies with moderate to high-risk bias were included. Fourteen clinical features met our criteria, including systolic blood pressure <100 mmHg (positive likelihood ratio [LR+]7.01), shock index >0.85, uterine cervical motion tenderness (LR+5.62 and negative likelihood ratio [LR-]8.60), and a self-assessment questionnaire score >70 (LR+12.20) or <25 (LR-0.19). Clinical diagnosis made by the clinician had the best rule-in ability (LR+24.6).

Conclusions: We identified 14 signs and symptoms that can influence the likelihood of a serious illness, including pain characteristics, systemic signs, gynaecological signs, and clinician's overall assessment. The risk of bias was moderate to high, leading to uncertainty and preventing us from making firm conclusions. This highlights the need for better research in this setting.

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来源期刊
BJGP Open
BJGP Open Medicine-Family Practice
CiteScore
5.00
自引率
0.00%
发文量
181
审稿时长
22 weeks
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