この子供は肺炎ですか? : 合理的な臨床検査の体系的レビュー

Sonal N Shah¹, Richard G Bachur¹, David L Simel^2,3

¹Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.

JAMA

|August 2, 2017

まとめ

子供の肺炎の診断の鍵となる指標は,低酸素と呼吸作業の増加です. 発熱やタキプネアのような一般的な症状は信頼性が低いもののこれらの兆候は臨床医が肺炎をより正確に特定するのに役立ちます

科学分野:

小児医学
診断の正確さ
呼吸器疾患

背景:

肺炎は子供の病気と死亡の重要な原因です.
抗生物質の過剰摂取を減らすためには診断が正確であることが重要です

研究の目的:

子どもの放射線肺炎を特定するための臨床症状と身体検査の診断の正確さを体系的に検討する.
肺炎を他の小児呼吸器疾患と区別する際の様々な兆候の有効性を評価する.

主な方法:

MEDLINEとEmbaseの検索で特定された23の診断研究 (13,833人の子供) の体系的なレビュー.
確率比,感度,および特異性は,症状と発見のために計算され,胸部X線写真の浸透液を基準基準とした.

主要な成果:

肺炎を確実に示す症状はありません胸の痛みは中程度の関連性を示した.
発熱とタキプニアは診断価値が限られていた. 中程度の低酸素症 (酸素飽和度 ≤96%) と呼吸作業の増加が最も重要な指標でした.
通常の酸素濃度 (酸素飽和度 > 96%) は肺炎の確率を低下させた.

結論:

低酸素症と呼吸の難しさは,タキプネアや聴診結果よりも,小児性肺炎の重要な指標です.
臨床的評価では,小児における肺炎の正確な診断のために,低酸素症と呼吸困難の徴候を優先すべきである.

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