この子供は虫炎を患っているのでしょうか?
David G Bundy1, Julie S Byerley, E Allen Liles
1Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. dbundy3@jhmi.edu
JAMA
|July 27, 2007
まとめ
発熱と反発感は,小児の臓炎を診断するための重要な指標です. 決定的ではないが,臨床的兆候と検査結果の組み合わせは,手術またはさらなる評価の必要性を決定するのに役立ちます.
科学分野:
- 小児医学は,小児科の医学である.
- 外科診断の診断について
- 臨床流行病学 臨床流行病学とは
背景:
- 腹痛は,一般的な,そしてしばしば挑戦的な小児の苦情です.
- 子どもにおける虫炎の正確な診断は,罹病率を減らすために極めて重要です.
- 臨床評価は,更なる診断作業と対比して,緊急の外科的診察を必要とする子どもを特定するのに役立ちます.
研究 の 目的:
- 子どもの盲腸炎の症状,徴候,および基本的な検査検査の診断の正確性を体系的に評価する.
- 虫炎を腹痛の他の原因から区別する臨床発見の精度を評価する.
- 小児の腹痛管理のための臨床的意思決定を伝えるために.
主な方法:
- MEDLINEとコクランデータベース (1966-2007年) の英語記事の体系的なレビュー.
- 含有基準:疑われる虫炎の子供 (≤18歳) に関する研究,臨床データを報告し,病理学またはフォローアップで診断が確認された.
- データを抽出し,42件の研究の質評価を行った.
主要な成果:
- 発熱 (LR 3.4) とリバウンド感 (LR 3.0) は,小児における炎の重要な指標である.
- 発熱の欠如 (LR 0.32) とリバウンド感 (LR 0.28) は,盲腸炎の確率を低下させる.
- 移動する腹痛 (LR 1.9-3.1) と特定の白血球数 (WBC <10,000/microL,LR 0.22;絶対中性粒子の数 <6750/microL,LR 0.06) も診断に役立ちます.
- 症状と徴候の組み合わせは,盲腸炎を排除するのに最も効果的です.
結論:
- 臨床検査は,決定的なものではありませんが,小児性虫炎における外科の相談やさらなる診断評価を導くのに価値があります.
- 子どもにおける虫炎の診断のための臨床検査の有用性は,より子ども特有の年齢層別データにより改善することができる.
- 臨床的発見と検査結果を組み合わせることで,小児性虫炎の診断の正確性が向上します.
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