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回顾性分析翻译

发布者:鑫达医学翻译 发布时间:2012-09-07阅读:

原文
Our study had a larger study popula- tion, compared with previous stud- ies.3,4 We defined our time of stroke di- agnosis as the time of neuroimaging
confirming stroke. Our study was per- formed in  a  tertiary  center  where there is close collaboration between pediatric neurologists and radiolo- gists, which makes use of the time of neuroimaging a more-reliable ap- proach to assess the time of stroke di- agnosis in our population. The results were not reviewed independently, and the timing of negative studies was not analyzed, because positive imaging re- sults represented an inclusion crite- rion. All  scans were evaluated by at- tending radiologists who were familiar with neuroimaging.  When assessment is performed with a suspicion of AIS, the radiologist’s interpretation of the neuroimaging scans at the Royal Chil- dren’s Hospital is conveyed immedi- ately to the referring doctor.
Other studies defined the time of AIS diagnosis to be the time the diagnosis was entered in the medical chart.4 We chose radiologic confirmation be- cause a suspected diagnosis or differ- ential diagnosis was documented by the first physician to see the patient for only 50% of our population and a suspicion of AIS was documented for only 26% of children. A limitation of our definition for determining the time to stroke diagnosis is that radiologic con- firmation may not equal clinical confir- mation; however, because there often are  delays or omissions in medical documentation, we think that the time to radiologic diagnosis is most likely to represent the true time to AIS diagno- sis in our population.
A limitation of this study is possible as- certainment bias, given the retrospec- tive design and limitations in ICD codes for diagnosing stroke. Almost 50% of the cases in our initial population were miscoded with ICD codes and did not represent AIS. However, all of the eligible stroke cases seen in our tertiary center were included in this study.

译文
    与既往研究相比,本研究纳入患者数量较多。本研究将卒中诊断时间定义为神经影像学确诊为卒中的时间。本研究开展于三级转诊中心,儿科神经学专家与放射学专家密切配合,易于实施神经影像学诊断,为我们测定卒中确诊时间提供了很大便利。本文并未对结果进行独立分析,也并未对阴性研究时间加以分析。所有扫描结果由熟悉神经影像学的住院放射学医师进行分析。对疑似AIS患者实施检查时,放射学医师将神经影像学检查结果及时反馈至诊断医师。
    其他研究将AIS确诊时间定义为将诊断写进病例时的时间。本文选用放射学确诊,其原因在于:医生初次检查后,50%的患者为疑似AIS或根据鉴别诊断排除其他发病可能。此外,儿童疑似AIS发病几率为26%。该方法的不足在于,放射学确诊可能与临床确诊时间不一致。然而,由于医师在病历写作过程中常出现延误或忽略相关内容等,因此我们认为放射学确诊时间更能代表本研究纳入患者的AIS确诊时间。
    在限定回顾性分析及卒中确诊国际疾病分类编码不明确的情况下,该研究存在的确认偏倚成为本研究的一项局限性。本研究50%的病例国际疾病分类编码存在错误,且编码并不能代表AIS。但是,本研究纳入所有转入我中心的卒中病例。
    其他局限性包括纳入患者均来自大型三级转诊儿童医院心内科,因此,心因性中风的发病几率要高于其他研究,所以并不适用于所有患者人群。但是,据此我们可以推断该高发病群体卒中诊断时间较大范围人群较短(换言之,其他群体的卒中诊断时间更长一些)。本研究发现17%的患者为新生儿,且多在其他医疗中心接受治疗(未在产科内与孕妇一起接受治疗)。 此外,本研究纳入的澳大利亚儿科群体内镰刀形细胞病发病几率并不高,且研究时排除患有烟雾病的患者。
 


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