直立倾斜试验操作医师累计工作量对血管迷走性晕厥诊断结果的影响性分析

Impact of Physician Cumulative Workload on the Diagnostic Results of the Head-up Tilt Test for Vasovagal Syncope

目的:探讨直立倾斜试验操作医师累计工作量对诊断报告结果的影响。方法:回顾性连续纳入中国医学科学院阜外医院自2016年1月1日至2022年12月31日进行直立倾斜试验检查的操作医师和患者资料。根据从本院开展倾斜试验至研究结束这一阶段医师的累计工作量,将医师分为低累计工作量组(累计50~100例)、中等累计工作量组(累计101~350例)、高累计工作量组(累计1000~4000例;无医师累计工作量在351~999例),以及按医师的的性别、学历、职称分别进行分组,分析不同分组内和不同分组间医师倾斜试验报告诊断率的差异。结果:共纳入22名医师操作的6122例患者,22名医师个体之间的阳性、可疑阳性和阴性报告率差异均具有统计学意义(P均<0.001)。中等累计工作量组平均可疑阳性报告率显著高于低累计工作量组和高累计工作量组(3.21%vs.1.09%vs.1.62%,P=0.001),女性医师可疑阳性报告率高于男性医师(2.25%vs.1.07%,P=0.017),本科学历医师可疑阳性报告率高于研究生学历医师(2.46%vs.1.52%,P=0.013),初级职称医师可疑阳性报告率高于中级和高级职称医师(3.40%vs.1.75%vs.2.53%,P=0.024)。多因素Logistic回归分析显示,不论以阴性还是阳性作参照,中等累计工作量均是可疑阳性报告的影响因素(P均<0.05)。结论:不同操作医师个体之间的倾斜试验诊断报告率存在一定差异,中等累计工作量组操作医师更易出具可疑阳性诊断报告。

Objectives:The purpose of this study is to evaluate the impact of the cumulative workload of HUTT testing physicians on diagnostic outcomes.Methods:This study retrospectively and consecutively included the data of testing physicians and patients who underwent HUTT at Fuwai Hospital,Chinese Academy of Medical Sciences,from January 2016 to December 2022.Based on the cumulative workload of physicians during the period from the initiation of tilt tests at the hospital to the end of the study,the physicians were categorized into low(50-100 sases),moderate(100-350 sases),and high(1000-4000 sases)cumulative workload groups,the cumulatie workload of no physician is 351-999 sases.Additionally,physicians were grouped by sex,educational background,and professional title to analyze differences in diagnostic rates of tilt table test reports within and between these groups.Results:The study included 22 testing physicians and 6122 patients.There were statistically significant differences in the rates of positive,suspicious positive,and negative reports among the 22 physicians(P<0.001).The average suspicious positive report rate in the moderate cumulative workload group was significantly higher than in the low and high cumulative workload groups(3.21%vs.1.09%vs.1.62%,P=0.001).The suspicious positive report rate was higher in the female physician group compared to the male physician group(2.25%vs.1.07%,P=0.017),in the undergraduate physician group compared to the postgraduate physician group(2.46%vs.1.52%,P=0.013),and in the junior title group compared to the intermediate and senior title groups(3.40%vs.1.75%vs.2.53%,P=0.024).Multivariate logistic regression analysis showed that a moderate cumulative workload was an influencing factor for suspicious positive reports,regardless of whether negative or positive was used as the reference(all P<0.05).Conclusions:There are certain differences in the diagnostic report rates of HUTT among different individual physicians.Physicians with a moderate cumulative workload are more likely to issue suspicious positive HUTT diagnostic reports.