【摘要】 目的了解急诊临床实践中临床决策方法的应用现状,探讨急诊医学临床决策方法应用方面存在的问题。方法由独立研究人员分析入选的1115份病例的诊断和处理过程,解析其临床决策方法的实践应用情况,比较低年制住院医师组(PG1)和高年制住院医师组(PG3+)临床决策方法应用的异同。结果临床应用四种主要临床决策方法分别为模式识别法(47.0%)、假设—演绎法(26.5%)、事件驱动法(12.3%)、运用规则法(3.2%)。PG1组和PG3+组临床决策方法的实践应用比较差异有统计学意义(χ2=153.21,P<0.001)。结论模式识别法和假设—演绎法是目前最常用的急诊医学临床决策方法。急诊高年制住院医师应用模式识别法更加普遍,而低年制住院医师更倾向于选择假设—演绎法。运用规则临床决策法在急诊中的应用明显不足。更多还原

【Abstract】 Objective To assess the application of main methodology to clinical decision in emergency medical practice and try to find out the inadequacy in this area.Methods 1115 critical patients were analyzed by independent investigators inspecting the application of the main clinical decision.The method of clinical decision was compared between PG1 group(defined as interns who has received emergency training no more than 1 year)and PG3+ group(defined as interns who has received emergency training at least 3 years).Results Of all the pauient’s treatment,47.0% were based on pattern recognition,26.5% on hypothetico-deductive,12.3% on event driven and 3.2% on “rule-using” algorithm respectively.The statistical analysis revealed a significant difference between PG1 group and PG3+group(χ2=153.21,P<0.001).Conclusion Pattern recognition and hypothetico-deductive serve as the most common methods used in emergency clinical practice now,with a preference of PG3+ group for pattern recognition and PG1 group for hypothetico-deductive respectively,but it seems that the application of “rule-using” algorithm is inadequate in emergency practice.更多还原