{"id":2047,"date":"2020-12-04T15:53:24","date_gmt":"2020-12-04T06:53:24","guid":{"rendered":"http:\/\/www.hcfm.jp\/journal\/?p=2047"},"modified":"2020-12-04T15:53:24","modified_gmt":"2020-12-04T06:53:24","slug":"%e3%83%9a%e3%83%8b%e3%82%b7%e3%83%aa%e3%83%b3%e3%82%a2%e3%83%ac%e3%83%ab%e3%82%ae%e3%83%bc%e3%81%ae%e3%83%aa%e3%82%b9%e3%82%af%e3%81%ae%e5%b1%a4%e5%88%a5%e5%8c%96","status":"publish","type":"post","link":"https:\/\/www.hcfm.jp\/journal\/?p=2047","title":{"rendered":"\u30da\u30cb\u30b7\u30ea\u30f3\u30a2\u30ec\u30eb\u30ae\u30fc\u306e\u30ea\u30b9\u30af\u306e\u5c64\u5225\u5316"},"content":{"rendered":"

\uff0d\u6587\u732e\u540d\uff0d
\nJason A. Trubiano, et al. Development and validation of a penicillin allergy clinical decision rule. JAMA Internal Medicine. 2020;180(5):745-752.<\/p>\n

\uff0d\u8981\u7d04\uff0d
\n\u25a0Importance\uff1a
\n\u30da\u30cb\u30b7\u30ea\u30f3\u30a2\u30ec\u30eb\u30ae\u30fc\u306f\u3001\u60a3\u8005\u3001\u6297\u83cc\u85ac\u7ba1\u7406\u30d7\u30ed\u30b0\u30e9\u30e0\u304a\u3088\u3073\u533b\u7642\u30b5\u30fc\u30d3\u30b9\u306b\u3068\u3063\u3066\u91cd\u8981\u306a\u554f\u984c\u3067\u3042\u308b\u3002\u5c02\u9580\u5bb6\u306b\u3088\u308b\u30da\u30cb\u30b7\u30ea\u30f3\u76ae\u819a\u691c\u67fb\u3092\u5fc5\u8981\u3068\u3057\u306a\u3044\u4f4e\u30ea\u30b9\u30af\u306e\u30da\u30cb\u30b7\u30ea\u30f3\u30a2\u30ec\u30eb\u30ae\u30fc\u3092\u7279\u5b9a\u3059\u308b\u305f\u3081\u306b\u3001\u59a5\u5f53\u6027\u3092\u8a55\u4fa1\u3055\u308c\u305fclinical decision rule\u304c\u6c42\u3081\u3089\u308c\u3066\u3044\u308b\u3002<\/p>\n

\u25a0Objective\uff1a
\n\u60a3\u8005\u304b\u3089\u5831\u544a\u3055\u308c\u305f\u30da\u30cb\u30b7\u30ea\u30f3\u30a2\u30ec\u30eb\u30ae\u30fc\u306epoint of care \u30ea\u30b9\u30af\u8a55\u4fa1\u3092\u53ef\u80fd\u306b\u3059\u308b\u30da\u30cb\u30b7\u30ea\u30f3\u30a2\u30ec\u30eb\u30ae\u30fc\u306eclinical decision rule\u3092\u958b\u767a\u3001\u691c\u8a3c\u3059\u308b\u3002<\/p>\n

\u25a0Design, setting, and participants\uff1a
\n\u3000\u3053\u306e\u7814\u7a76\u3067\u306f\u3001\u30aa\u30fc\u30b9\u30c8\u30e9\u30ea\u30a2\u306e\u30e1\u30eb\u30dc\u30eb\u30f3\u306b\u3042\u308b2\u3064\u306e\u4e09\u6b21\u533b\u7642\u6a5f\u95a2\uff08Austin Health and Peter MacCallum Cancer Centre\uff09\u304b\u3089\u306e622\u4eba\u306e\u60a3\u8005\uff08\u591a\u65bd\u8a2d\u3001\u524d\u5411\u304d\u3001\u6297\u83cc\u85ac\u30a2\u30ec\u30eb\u30ae\u30fc\u30c6\u30b9\u30c8\u304c\u884c\u308f\u308c\u305f\u30b3\u30db\u30fc\u30c8\uff09\u304c\u53c2\u52a0\u3057\u3066\u3001\u30da\u30cb\u30b7\u30ea\u30f3\u30a2\u30ec\u30eb\u30ae\u30fc decision rule\u306e\u958b\u767a\u3068\u5185\u7684\u59a5\u5f53\u6027\u306e\u8a55\u4fa1\u3092\u884c\u3063\u305f\u3002\u30ed\u30b8\u30b9\u30c6\u30a3\u30c3\u30af\u89e3\u6790\u30fb\u5909\u6570\u6e1b\u5c11\u6cd5\u3092\u4f7f\u7528\u3057\u3066\u30da\u30cb\u30b7\u30ea\u30f3\u30a2\u30ec\u30eb\u30ae\u30fc\u30c6\u30b9\u30c8\u306e\u967d\u6027\u7d50\u679c\u3092\u4e88\u6e2c\u3059\u308b\u81e8\u5e8a\u5909\u6570\u3092\u542b\u3080\u30e2\u30c7\u30eb\u3092\u5c0e\u304d\u51fa\u3057\u305f\u3002\u6700\u7d42\u30e2\u30c7\u30eb\u306e\u5185\u7684\u59a5\u5f53\u6027\u306e\u8a55\u4fa1\u306b\u306f\u3001Bootstrapped sample\uff08\u203b1\uff09\u3068\u4fc2\u6570\u304b\u3089\u5c0e\u51fa\u3055\u308c\u305f\u30e2\u30c7\u30eb\u30b9\u30b3\u30a2\u30ea\u30f3\u30b0\u3092\u4f7f\u7528\u3057\u305f\u3002\u5916\u7684\u59a5\u5f53\u6027\u306e\u8a55\u4fa1\u306f\u3001\u30aa\u30fc\u30b9\u30c8\u30e9\u30ea\u30a2\u306e\u30b7\u30c9\u30cb\u30fc\u3068\u30d1\u30fc\u30b9\u3001\u30c6\u30cd\u30b7\u30fc\u5dde\u306e\u30ca\u30c3\u30b7\u30e5\u30d3\u30eb\u304b\u3089\u306e945\u4eba\u306e\u60a3\u8005\uff08\u5f8c\u5411\u304d\u3001\u6297\u83cc\u85ac\u30a2\u30ec\u30eb\u30ae\u30fc\u30c6\u30b9\u30c8\u304c\u884c\u308f\u308c\u305f\u30b3\u30db\u30fc\u30c8\uff09\u3067\u5b9f\u65bd\u3055\u308c\u305f\u3002\u30da\u30cb\u30b7\u30ea\u30f3\u30a2\u30ec\u30eb\u30ae\u30fc\u3092\u5831\u544a\u3057\u305f\u60a3\u8005\u306f\u3001\u76ae\u819a\u30d7\u30ea\u30c3\u30af\u30c6\u30b9\u30c8\u3001\u76ae\u5185\u30c6\u30b9\u30c8\u3001\u30d1\u30c3\u30c1\u30c6\u30b9\u30c8\u3068\u7d4c\u53e3\u30c1\u30e3\u30ec\u30f3\u30b8\uff08\u76f4\u63a5\u307e\u305f\u306f\u76ae\u819a\u30c6\u30b9\u30c8\u5f8c\uff09\u3092\u7d44\u307f\u5408\u308f\u305b\u305f\u30a2\u30ec\u30eb\u30ae\u30fc\u30c6\u30b9\u30c8\u3092\u53d7\u3051\u305f\u3002\u30c7\u30fc\u30bf\u306f2008\u5e746\u670826\u65e5\u304b\u30892019\u5e746\u67083\u65e5\u307e\u3067\u53ce\u96c6\u3055\u308c\u30012019\u5e741\u67089\u65e5\u304b\u308912\u65e5\u307e\u3067\u5206\u6790\u304c\u884c\u308f\u308c\u305f\u3002
\n\u203b1\uff1a\u6bcd\u96c6\u56e3\u3068\u306a\u308b\u30c7\u30fc\u30bf\u304c\u3042\u308b\u6642\u306b\u3001\u6bcd\u96c6\u56e3\u304b\u3089\u91cd\u8907\u3092\u8a31\u3057\u3066\u30e9\u30f3\u30c0\u30e0\u306b\u3044\u304f\u3089\u304b\u30c7\u30fc\u30bf\u3092\u53d6\u308a\u51fa\u3057\u3066\u518d\u6a19\u672c\u5316\u3059\u308b\u624b\u6cd5\u3002\u4e88\u6e2c\u30e2\u30c7\u30eb\u306e\u751f\u6210\u306b\u4f7f\u308f\u308c\u308b\u3002<\/p>\n

\u25a0Main outcomes and measures\uff1a
\n\u3000Primary outcome\u306f\u3001\u5916\u6765\u307e\u305f\u306f\u5165\u9662\u60a3\u8005\u306e\u30da\u30cb\u30b7\u30ea\u30f3\u30a2\u30ec\u30eb\u30ae\u30fc\u30c6\u30b9\u30c8\u967d\u6027\u3068\u3044\u3046\u7d50\u679c\u3002<\/p>\n

\u25a0Results\uff1a
\n\u3000\u30e2\u30c7\u30eb\u306e\u958b\u767a\u304a\u3088\u3073\u5185\u7684\u59a5\u5f53\u6027\u306e\u8a55\u4fa1\u306b\u7528\u3044\u3089\u308c\u305f\u30b3\u30db\u30fc\u30c8622\u4eba\uff08\u5973\u6027367\u4eba\uff0859%\uff09\u3001\u5e74\u9f62\u4e2d\u592e\u502460\u6b73\uff08\u56db\u90e8\u4f4d\u7bc4\u56f248-71\u6b73\uff09\uff09\u3001\u5916\u7684\u59a5\u5f53\u6027\u306e\u8a55\u4fa1\u306b\u7528\u3044\u3089\u308c\u305f\u30b3\u30db\u30fc\u30c8945\u4eba\uff08\u5973\u6027662\u4eba\uff0870.1%\uff09\u3001\u5e74\u9f62\u4e2d\u592e\u502455\u6b73\uff08\u56db\u90e8\u4f4d\u7bc4\u56f238-68\u6b73\uff09\uff09\u304b\u3089\u3001\u591a\u5909\u91cf\u89e3\u6790\u306b\u3088\u308a\u30da\u30cb\u30b7\u30ea\u30f3\u30a2\u30ec\u30eb\u30ae\u30fc\u30c6\u30b9\u30c8\u967d\u6027\u306b\u95a2\u9023\u3059\u308b4\u3064\u306e\u7279\u5fb4\u306f\u3001PEN-FAST\uff08penicillin allergy, five or fewer years ago, anaphylaxis\/angioedema, severe cutaneous adverse reaction(SCAR), and treatment required for allergy episode\uff09\u3068\u3044\u3046\u7565\u8a9e\u306b\u307e\u3068\u3081\u3089\u308c\u305f\u3002\u5927\u57fa\u6e96\uff08major criteria\uff09\u306b\u306f\u30015\u5e74\u4ee5\u5185\u306b\u767a\u751f\u3057\u305f\u30a2\u30ec\u30eb\u30ae\u30fc\u30a4\u30d9\u30f3\u30c8\uff082\u70b9\uff09\u3001\u30a2\u30ca\u30d5\u30a3\u30e9\u30ad\u30b7\u30fc\/\u8840\u7ba1\u6d6e\u816b\u3082\u3057\u304f\u306fSCAR\uff082\u70b9\uff09\u304c\u3001\u5c0f\u57fa\u6e96\uff08minor criterion\uff09\u306b\u306f\u30a2\u30ec\u30eb\u30ae\u30fc\u306b\u6cbb\u7642\u3092\u8981\u3057\u305f\u3068\u3044\u3046\u30a8\u30d4\u30bd\u30fc\u30c9\uff081\u70b9\uff09\u304c\u542b\u307e\u308c\u305f\u3002\u5185\u7684\u59a5\u5f53\u6027\u306e\u8a55\u4fa1\u3067\u306f\u3001AUC 0.805\uff08\u203b2\uff09\u3001minimal mean optimism\uff08\u203b3\uff09 0.003\u3060\u3063\u305f\u3002\u30da\u30cb\u30b7\u30ea\u30f3\u30a2\u30ec\u30eb\u30ae\u30fc\u4f4e\u30ea\u30b9\u30af\u306e\u5206\u985e\u306b\u306f\u3001PEN-FAST 3\u70b9\u4ee5\u4e0b\u304c\u30ab\u30c3\u30c8\u30aa\u30d5\u3068\u8a2d\u5b9a\u3055\u308c\u307e\u3057\u305f\u3002\u3053\u306e\u5834\u5408\u3001460\u4eba\u306e\u60a3\u8005\u306e\u3046\u306117\u4eba\uff083.7%\uff09\u306e\u307f\u304c\u30a2\u30ec\u30eb\u30ae\u30fc\u30c6\u30b9\u30c8\u967d\u6027\u3068\u306a\u308a\u3001\u9670\u6027\u4e88\u6e2c\u5024\u306f96.3%\uff0895%CI\u300194.1%-97.8%\uff09\u3060\u3063\u305f\u3002\u307e\u305f\u3001\u5916\u7684\u59a5\u5f53\u6027\u306e\u8a55\u4fa1\u3067\u3082\u540c\u69d8\u306e\u7d50\u679c\u304c\u5f97\u3089\u308c\u307e\u3057\u305f\u3002
\n\u203b2\uff1aAUC\u306e\u8a3a\u65ad\u7cbe\u5ea6\u306e\u76ee\u5b89 0.7-0.8 fair, 0.8-0.9 good, 0.9-1.0 excellent
\n\u203b3\uff1aoptimism\u3068\u306f\u3001\u30e2\u30c7\u30eb\u306e\u4e88\u6e2c\u7cbe\u5ea6\u306e\u904e\u5927\u8a55\u4fa1\u306e\u30d0\u30a4\u30a2\u30b9<\/p>\n

\u25a0Conclusion and relevance\uff1a
\n\u3053\u306e\u7814\u7a76\u3067\u3001PEN-FAST\u306f\u3001\u6b63\u5f0f\u306a\u30a2\u30ec\u30eb\u30ae\u30fc\u30c6\u30b9\u30c8\u3092\u5fc5\u8981\u3068\u3057\u306a\u3044\u4f4e\u30ea\u30b9\u30af\u306e\u30da\u30cb\u30b7\u30ea\u30f3\u30a2\u30ec\u30eb\u30ae\u30fc\u3092\u6b63\u78ba\u306b\u7279\u5b9a\u3067\u304d\u308b\u7c21\u4fbf\u306a\u57fa\u6e96\u3067\u3042\u308b\u3053\u3068\u3068\u8a3c\u660e\u3055\u308c\u305f\u30023\u70b9\u672a\u6e80\u306ePEN-FAST\u30b9\u30b3\u30a2\u306f\u9ad8\u3044\u9670\u6027\u4e88\u6e2c\u5024\u3092\u6709\u3059\u308b\u3068\u3044\u3046\u7d50\u679c\u304b\u3089\u3001\u81e8\u5e8a\u533b\u306b\u3068\u3063\u3066\u3001\u3042\u308b\u3044\u306f\u6297\u83cc\u85ac\u7ba1\u7406\u30d7\u30ed\u30b0\u30e9\u30e0\u306b\u304a\u3044\u3066\u3001\u30da\u30cb\u30b7\u30ea\u30f3\u30a2\u30ec\u30eb\u30ae\u30fc\u4f4e\u30ea\u30b9\u30af\u3092point of care\u3067\u7279\u5b9a\u3059\u308b\u305f\u3081\u306b\u5f79\u7acb\u3064\u3068\u3044\u3046\u3053\u3068\u304c\u793a\u5506\u3055\u308c\u305f\u3002<\/p>\n

\"JC202010\u5800\u307f\uff11\"<\/a><\/p>\n

\"JC202010\u5800\u307f\uff12\"<\/a><\/p>\n

\"JC202010\u5800\u307f\uff13\"<\/a><\/p>\n

\"JC202010\u5800\u307f\uff14\"<\/a><\/p>\n

\u25a0Limitation\uff1a
\n\u30fb\u975e\u30da\u30cb\u30b7\u30ea\u30f3\u03b2-\u30e9\u30af\u30bf\u30e0\u7cfb\u6297\u83cc\u85ac\u30a2\u30ec\u30eb\u30ae\u30fc\u3001\u9759\u8108\u5185\u6295\u4e0e\u3067\u306e\u307f\u8d77\u3053\u308b\u30da\u30cb\u30b7\u30ea\u30f3\u30a2\u30ec\u30eb\u30ae\u30fc\u304c\u9664\u5916\u3055\u308c\u3066\u3044\u308b
\n\u30fbSCAR\u306e\u3088\u3046\u306a\u30a2\u30ec\u30eb\u30ae\u30fc\u8868\u73fe\u578b\u3092\u6301\u3064\u60a3\u8005\u304c\u5c11\u306a\u3044
\n\u30fb\u4e88\u6e2c\u30e2\u30c7\u30eb\u306e\u751f\u6210\u306b\u969b\u3057\u3066\u3001\u5165\u9662\u60a3\u8005\u306e\u5272\u5408\u304c\u591a\u304b\u3063\u305f
\n\u30fb\u6210\u4eba\u60a3\u8005\u306e\u307f\u3057\u304b\u9069\u7528\u3067\u304d\u306a\u3044
\n\u30fb\u30da\u30cb\u30b7\u30ea\u30f3\u30a2\u30ec\u30eb\u30ae\u30fc\u3068\u30a2\u30ec\u30eb\u30ae\u30fc\u8868\u73fe\u578b\u306e\u6709\u75c5\u7387\u304c\u5909\u5316\u3059\u308b\u53ef\u80fd\u6027\u304c\u9ad8\u3044\u3001\u6c11\u65cf\u306b\u3088\u308b\u9055\u3044\u306e\u691c\u8a3c\u306f\u30cd\u30af\u30b9\u30c8\u30b9\u30c6\u30c3\u30d7<\/p>\n

\u3010\u958b\u50ac\u65e5\u30112020\u5e7411\u67084\u65e5\uff08\u6c34\uff09<\/p>\n","protected":false},"excerpt":{"rendered":"

\uff0d\u6587\u732e\u540d\uff0d Jason A. Trubiano, et al. Development and validation of a penicillin allergy clinical decision rule. JAM … \u7d9a\u304d\u3092\u8aad\u3080 \u30da\u30cb\u30b7\u30ea\u30f3\u30a2\u30ec\u30eb\u30ae\u30fc\u306e\u30ea\u30b9\u30af\u306e\u5c64\u5225\u5316<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[22,17],"tags":[],"class_list":["post-2047","post","type-post","status-publish","format-standard","hentry","category-22","category-17"],"_links":{"self":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/2047","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2047"}],"version-history":[{"count":1,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/2047\/revisions"}],"predecessor-version":[{"id":2052,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/2047\/revisions\/2052"}],"wp:attachment":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2047"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=2047"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=2047"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}