中医临床案例证素辨识一致性研究

目的:评价中医临床案例证素辨识的一致性及证素辅助诊断参考在临床案例证素辨识中的作用。方法:从规范四诊信息的中医大型临床案例数据库中随机抽取50个案例,采用两轮德尔菲专家咨询法,针对每一个案例邀请4位专家做出证素辨识,两轮咨询间隔一周以上。第一轮仅给予50个临床案例的四诊资料,请专家逐一作出证素辨识;第二轮在给予证素辅助诊断参考的前提下,请相同4位专家对上述50个临床案例再次做出证素辨识。两轮证素辨识一致性均采用肯德尔和谐系数进行评价。结果:第一轮专家证素辨识涉及37个证素,其中23个证素(占62%)通过一致性评价;第二轮专家证素辨识涉及29个证素,其中19个证素(占66%)通过一致性评价;两轮专家咨询各证素辨识一致性之间的差异没有统计学意义。结论:多位中医专家对同一临床案例的证素辨识存在一定的不一致性,而给予专家证素辅助诊断参考,对专家做出一致的证素辨识不一定具有促进作用。

Consistency Study on Syndrome Elements Identification of Clinical Cases in Traditional Chinese Medicine

Objective:To evaluate the consistency of syndrome identification of clinical cases in traditional Chinese medicine(TCM) and the effect of syndrome elements auxiliary diagnostic reference of clinical cases in TCM. Methods:Total 50 cases were randomly selected from the large clinical case database of TCM,which have standard four diagnostic information. Four experts were invited to make syndrome elements identification for each case by methods of twice,Delphi expert consultation which is at an interval of more than one week. In the first round,only the four diagnostic information about the 50 clinical cases were given to experts to make the syndrome elements identification. In the second round,the syndrome elements were given as the auxiliary reference,inviting the same 4 experts to make the identification for the above50 clinical cases again. The consistency of two rounds of syndrome elements identification were evaluated by Kendall's harmonious coefficient. Results:Total 37 syndrome elements were involved in the first round of expert identification,of which 23 syndrome elements(62%) passed through consistency evaluation. Total 29 syndrome elements were involved in the second round of expert identification,of which 19 syndrome elements(66%) passed through consistency evaluation. Therefore,two rounds of expert consultation with syndrome elements identification consistency between the difference was not statistically significant. Conclusion:Syndrome identification in the same clinical cases from many TCM experts was not consistent. The syndrome element auxiliary diagnostic reference didn't have the necessarily effects on promoting experts to make consistent syndrome elements diagnosis.