Screening Methods, Based On Experts' Experience And Clinical Stroke Syndrome Differentiation Scale Entry

ObjectiveThe research is in order to inquire into the useful method of selecting the items of apoplexy scale according to differentiation of symptoms by combining experts'experience with clinical symptoms. To combine the experts'experience with clinical symptoms the research gets the diagnostic significant information of four examination methods of the common syndrome factors in clinic by applying on Delphi method using the specialist questionnaire and using statistical methods to analyze clinical symptoms.MethodThis research is a part of National Emphasis Foundation Research Development Plan(973plan)-- Study of diagnostic standard and the system of curative effect of ischemic stroke by combining syndromes with disease(Project Number: 2003CB517102). Taking the two syndrome factors named QI deficiency and endogenous fire as an example, the research includes two major parts. One part is to select the items of apoplexy scale according to differentiation of symptoms which have the diagnostic significant meaning for the two syndrome factors by applying on Delphi method using the specialist questionnaire. This way may provide items from importance. The other part is to select items of apoplexy scale according to differentiation of symptoms by analyzing clinical symptoms. It gets the diagnostic significant items of the two syndrome factors by analyzing the information of four examination methods which are provided by predictive, many centers, great samples, dynamic continuous case-investigation of apoplexy using Chi-square test and factor analysis. Then choose the items which are selected by both experts and analyzing clinical symptoms as the final items of apoplexy scale according to differentiation of symptoms.Result1.The items of apoplexy scale according to differentiation of symptoms selected by experts experience include such items.1.1 The items of apoplexy scale of differentiation of symptoms for endogenous fire in acute period selected by experts include restlessness, dysphoria and easy angriness, delirium, congested face, conjunctival congestion, dried up lips, yellow phlegm, fever, feel distended and painful on head, bad smell in mouth, dryness of mouth, feeling thirsty with preference to cold drinking, dry defecation, without defecation for three days, without defecation for five days, yellow urination, yellow tongue coating, dry tongue coating, reddened tongue, deep-red tongue, reddened and deep-red tongue, taut and rapid pulse, rapid pulse, smooth and rapid pulse, smooth pulse.1.2 The items of apoplexy scale of differentiation of symptoms for qi deficiency in acute period selected by experts include tired in mind and weak strength, weariness and feeling like lying in bed, deficiency of qi and not feeling like talking, faint breath, speaking lowly, spontaneous sweating when moving slightly, spontaneous sweating in a quiet state, spontaneous sweating, pale complexion, pale and swollen complexion, pale lip, weak and limp limbs, palpitation when moving a little, palpitation when moving more, fat tongue, tongue with edge covering with teeth prints, fat and covered with teeth prints tongue, light tongue, feeble pulse, weak pulse.1.3 The items of apoplexy scale of differentiation of symptoms for qi deficiency in period of recovering selected by experts include tired in mind and weak strength, weariness and feeling like lying in bed, deficiency of qi and not feeling like talking, speaking lowly, pale lip, weak and limp limbs, spontaneous sweating, spontaneous sweating when moving slightly, thready pulse, deep and thready pulse, weak pulse, indistinctive pulse, feeble pulse, fat tongue, tongue with edge covering with teeth prints, fat and covered with teeth prints tongue, light tongue.1.4 The items of apoplexy scale of differentiation of symptoms for endogenous fire in period of recovering selected by experts include restlessness, dysphoria and angriness, congested face, bitter taste and dry throat, yellow phlegm, dry defecation, without defecation for three days, without defecation for five days, yellow urination, reddened tongue, deep-red tongue, reddened and deep-red tongue, yellow tongue coating, dry tongue coating, smooth and rapid pulse, rapid pulse, taut and rapid pulse.2. The items of apoplexy scale according to differentiation of symptoms selected by analyzing clinical symptoms include such items.2.1 The items of apoplexy scale of differentiation of symptoms for endogenous fire in acute period selected by analyzing clinical symptoms include easy angry, dysphoria, restlessness, vexation, feverish sensation in the centre of hands and feet, feverish sensation in the back of hands, slight fever, fever seriously at night, conjunctival congestion, dried up lips, congested face, tidal red in two cheekbones, deep-red lips, boil in lip and mouse, feel of pain and beating in head, feeling distended in head, having a low ringing sensation in the ears, bad smell in mouth, dryness of mouth, dry tongue, feeling thirsty with preference to cold drinking, yellow phlegm, abrupt pulse, rapid pulse, smooth pulse, taut pulse, yellow tongue coating, dry tongue coating, thick tongue coating, reddened tongue, deep-red tongue, dry defecation, yellow urination.2.2 The items of apoplexy scale of differentiation of symptoms for qi deficiency in acute period selected by analyzing clinical symptoms include weak strength, tired in mind, deficiency of qi, shortness of breath, faint breath, palpitation, feeling depressed in chest, numbness of skin, spontaneous sweating, cold sweat, pale complexion, sallow complexion, pale lip, incontinence of urine, loose bowels, defecating tight stool firstly then loose stool, swelling in hands and feet, weak and limp limbs, loose hands, light tongue, light and pale tongue, light and red tongue, tongue with edge covered with teeth prints, knotted pulse, intermittent pulse, weak pulse, thready pulse, deep pulse, slow pulse, soft pulse.2.3 The items of apoplexy scale of differentiation of symptoms for qi deficiency in the period of recovering selected by analyzing clinical symptoms include tired in mind, weak strength, somnolence, speaking lowly, sallow complexion, pale complexion, pale lips, palpitation, feeling suffocated, feeling depressed in chest, shortness of breath, deficiency of qi, spontaneous sweating, swelling in hands, weak and limp limbs, light and pale tongue, light and red tongue, defecating tight stool firstly then loose stool, incontinence of urine, slow pulse, thready pulse, deep pulse, weak pulse.2.4 The items of apoplexy scale of differentiation of symptoms for endogenous fire in the period of recovering selected by analyzing clinical symptoms include dysphoria,easy angry,vexation,congested face, tidal red in two cheekbones ,conjunctival congestion,deep-red lips,dried up lips,feeling distended in head,dysphoria with feverish sensation in chest, palms and soles,feverish sensation in the centre of hands and feet, serious fever in night,acid regurgitation,feeling thirsty with preference to cold drinking, dry tongue,bitter taste, dryness of mouth,bad smell in mouth, yellow tongue coating, thick tongue coating,dry tongue coating, reddened tongue,deep-red tongue, yellow urination, dry defecation, rapid pulse, smooth pulse.3. Sellection of the items of apoplexy scale according to differentiation of symptoms The final items of apoplexy scale according to differentiation of symptoms include such items which are selected by both experts and analyzing clinical symptoms.3.1 The final items of apoplexy scale according to differentiation of symptoms for endogenous fire in acute period include restlessness, dysphoria and easy angriness, congested face, conjunctival congestion, dried up lips, bad smell in mouth, dryness of mouth, feeling thirsty with preference to cold drinking, yellow phlegm, dry defecation, yellow urination, yellow tongue coating, dry tongue coating, reddened tongue, deep-red tongue, rapid pulse, taut pulse.3.2 The final items of apoplexy scale according to differentiation of symptoms for qi deficiency in acute period include weak strength, tired in mind, deficiency of qi and not feeling like talking, faint breath, spontaneous sweating, pale complexion, white lip, weak and limp limbs, palpitation, tongue with edge covered with teeth prints, light tongue, weak pulse. 3.3 The final items of apoplexy scale according to differentiation of symptoms for endogenous fire in the period of recovering include dysphoria and easy angriness, congested face, dry defecation, yellow urination, reddened tongue, deep-red tongue, yellow tongue coating, dry tongue coating, rapid pulse, bitter taste in mouth.3.4 The final items of apoplexy scale according to differentiation of symptoms for qi deficiency in the period of recovering include tired in mind and weak strength, speaking lowly, white lip, weak and limp limbs, spontaneous sweating, thready pulse, weak pulse, deficiency of qi.Conclusion1. Selecting items of scale according to differentiation of symptoms by experts can provide items from importance. It is an useful way to consult and follow Delphi method in order to get the experts'experience which can provide items from importance. So consulting and following Delphi is a valid method to select items of scale of differentiation of symptoms and build up the diagnosis standard of syndromes.2. It is necessary for building up the scale of differentiation of symptoms to combine experts'experience with clinical symptoms tightly.3. To select the items of scale according to differentiation of symptoms it is important to consider the importance, independence, sensitivity and clinical operation. And it is an important thing to consider the rate of appearance in clinic.4. It is needed that to be researched deeply and be verified by experts and clinical study in order to confirm the final items of apoplexy scale of differentiation of symptoms.