BACKGROUND:Many clinicians use a global visual interpretation of patient appearance to decide if a patient looks sick or not. For patients with suspected acute pulmonary embolism (PE), we tested the relationship between visual appearance of a happy patient facial affect and probability of PE+ on CT pulmonary angiography (CTPA). METHODS:Eligible patients were selected by usual care to undergo CTPA, the criterion standard for PE+ or PE-. Prior to CTPA result, trained study personnel obtained physician pretest probability using the gestalt method (visual analogue scale, 0%-100%), the Wells score (0-12) and physicians' impression of whether the patient smiled during the initial examination (smile+). Patients' faces were also video recorded and analysed with an automated neural network-based algorithm (Noldus FaceReader) for happy affect. RESULTS:Of the 208 patients enrolled, 27 were PE+ and smile+ was more frequent in patients with PE+ than PE-, a finding confirmed by the Noldus. The diagnostic sensitivity and specificity of smile was low, and physicians overestimated presence of an alternative diagnosis more likely to PE with smile+ than smile- patients in patients with true PE. As a result, the area under the receiver operating characteristic curve (AUROC) was lower for the Wells score in smile+ patients. However, the physicians' mean gestalt estimate of PE did not differ with smile status, nor did smile status affect the AUROC for gestalt. CONCLUSIONS:In patients with suspected PE, physician recollection of patients' smile+ was more common in PE+ patients, and was associated with a less accurate Wells score, primarily because physicians overestimated probability of alternative diagnosis. However, the overall diagnostic accuracy of physicians' gestalt did not differ with perceived smile status. These data suggest that the patients' smile had less effect on the numeric gestalt pretest probability assessment than on the binary decision about an alternative diagnosis.

译文

背景:许多临床医生使用患者外观的整体视觉解释来确定患者是否生病。对于疑似急性肺栓塞(PE)的患者,我们测试了患者面部表情愉悦的视觉外观与CT肺血管造影(CTPA)上PE的可能性之间的关系。
方法:通过常规护理选择符合条件的患者接受CTPA,即PE或PE-的标准标准。在获得CTPA结果之前,训练有素的研究人员使用格式塔方法(视觉模拟量表,0%-100%),Wells评分(0-12)和医生对患者在初次检查时是否微笑的印象来获得医师的预测概率(微笑 )。还对患者的面部进行了视频记录,并使用基于自动神经网络的算法(Noldus FaceReader)进行了分析,以取得快乐的效果。
结果:在208名患者中,有27名是PE,PE患者的笑容比PE-高,Noldus证实了这一发现。微笑的诊断敏感性和特异性较低,并且医生高估了真正的PE患者比微笑患者更容易出现微笑的PE的替代诊断。结果,微笑患者的Wells评分接收器工作特征曲线(AUROC)下的面积较低。然而,医生对PE的平均格式塔估计值与微笑状态没有差异,微笑状态也不会影响AUROC的格式塔。
结论:在怀疑患有PE的患者中,医师对患者微笑的回忆在PE患者中更为常见,并且与Wells评分的准确性较低有关,这主要是因为医师高估了替代诊断的可能性。但是,医生的格式塔的总体诊断准确性与所感知的微笑状态没有差异。这些数据表明,患者的微笑对数字格式塔预测试概率评估的影响小于对替代诊断的二元决策的影响。

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