この咳をする若者や大人の患者さんは pertussis ですか?
Paul B Cornia1, Adam L Hersh, Benjamin A Lipsky
1Primary and Specialty Medical Care Service, Veterans Affairs Puget Sound Health Care System, and Department of Medicine, University of Washington School of Medicine, Seattle, USA.
JAMA
|August 26, 2010
まとめ
百日咳は,大人と青少年ではしばしば見逃されます. 咳後の嘔吐とインスピラタリー・ウィープは,咳の可能性をわずかに高めますが,臨床的判断は診断の鍵です.
科学分野:
- 感染症 感染症は感染症です.
- クリニカル診断士
- 公衆衛生は公衆衛生である.
背景:
- 百日咳は,青少年および成人の慢性咳の原因としてしばしば過小評価されています.
- パロキシズム性咳,ポストゥッシブ・エメシス,インスピラトリー・ウィープのようなクラシックな pertussis 症状の診断価値は十分に確立されていません.
研究 の 目的:
- 3つの古典的な pertussis 症状の診断的有用性を体系的にレビューする: 偏熱性咳,後発吐性嘔吐,およびインスピレーション性 whoop.
- 5歳以上の個人,青少年,および成人における pertussis を診断する際にこれらの症状の証拠を評価する.
主な方法:
- MEDLINEとEMBASEのデータベース (1966-2010) で体系的な文献検索が行われました.
- 含まれた研究は,咳の病気と,基準基準を用いた確認された pertussis 診断を持つ患者を対象としたものです.
- データ抽出と分析は,2人の著者によって独立して行われました.
主要な成果:
- 5歳以上の患者,青少年,成人を含む3つの前向きな研究が分析されました.
- 咳後の嘔吐 (LR: 1.8) またはインスピラトリーホープ (LR: 1.9) の存在は, pertussis.の確率を高めました.
- 発熱性咳 (LR:0.52) や発熱後の嘔吐 (LR:0.58) の欠如は,その可能性を低下させ,インスピレーション性フープの欠如は,情報提供が少なくなった (LR:0.78).
結論:
- 古典的な pertussis 症状の診断価値のための証拠は限られており,アウトブレイクのない環境では質が低いです.
- 咳後の嘔吐とインスピラータリーホープは, pertussis の確率をわずかに変化させるだけです.
- 臨床的判断は,さらなる試験または実証的治療の決定を導くために不可欠です.
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