常规电子健康记录中呼吸终点术语标准化：为何仍难达成一致
本文讨论常规电子健康记录（EHR）中呼吸终点术语标准化为何仍难以达成一致。引言指出，临床指南与卫生政策日益依赖常来自EHR的真实世界数据，而随机对照试验（RCT）虽被视为因果推断金标准，却因严格入选和受控条件存在外推局限。文章还提示不同研究设计回答不同问题，RCT并非总能适用于重要临床问题。
要点
- 常规电子健康记录中呼吸终点术语标准化仍难以形成一致意见。
- 临床指南与卫生政策日益利用常来自电子健康记录的真实世界数据。
- 随机对照试验严格入选和受控条件提高内部效度，却降低常规诊疗外推性。
核心结论
- 常规电子健康记录中呼吸终点术语标准化为何仍难达成一致，是本文关注的核心问题。
研究设计与样本
- 围绕常规电子健康记录中呼吸终点术语标准化展开的论述性文章。
主要发现
- 临床指南与卫生政策日益利用常来自电子健康记录的真实世界数据，以优化疾病预防、诊断和管理。
- 随机对照试验因能控制混杂，传统上被视为建立干预与结局因果关系的金标准。
- 随机对照试验的严格入选和受控条件提高内部效度，但降低对常规诊疗的外推性。
- 临床试验人群常排除存在复杂共病者，且不同研究设计回答不同研究问题。
- 随机对照试验并非总能适用于回答许多重要临床问题。
临床怎么用
- 临床与政策使用常规EHR真实世界数据时，需注意呼吸终点术语一致性问题。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
Introduction Clinical practice guidelines and healthcare policies increasingly leverage real-world data, often retrieved from electronic healthcare records (EHRs), to optimise disease prevention, diagnosis and management. 1 Traditionally, randomised controlled trials (RCTs) have been regarded as the gold standard for establishing causal relationships between interventions and outcomes, primarily due to their control over confounding factors. However, RCTs face what has been called the clinical trial paradox wherein their strict inclusion criteria and tightly controlled conditions improve internal validity but reduce generalisability to routine care settings. 2 3 It is well known that clinical trial populations exclude people with complex morbidity. 4 5 Additionally, different research designs answer different research questions and RCTs are not always fit for purpose to answer many important clinical questions. While strict criteria and conduct of RCTs indeed ensure internal validity on drug efficacy, external validity on drug...
引用
- Thorax：Standardising terminology in routine electronic health records for respiratory endpoints: why we still can't agree
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。