这个孩子有尾炎吗?
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
概括
发烧和反弹疼痛是诊断儿童尾炎的关键指标. 虽然没有确定性,但临床症状与实验室结果相结合,有助于确定需要手术或进一步评估.
科学领域:
- 儿科医学 儿科医学
- 手术诊断手术诊断的使用方法
- 临床流行病学临床流行病学
背景情况:
- 腹痛是一种常见的,经常具有挑战性的儿科投诉.
- 准确诊断儿童尾炎对于降低发病率至关重要.
- 临床评估有助于识别需要立即外科咨询的儿童与进一步的诊断工作.
研究的目的:
- 系统地评估儿童尾炎的症状,征兆和基本实验室检查的诊断准确性.
- 评估临床发现的准确性,以区分尾炎与腹部疼痛的其他原因.
- 为儿童腹痛管理的临床决策提供信息.
主要方法:
- 从MEDLINE和Cochrane数据库 (1966-2007) 中对英语文章进行系统审查.
- 纳入标准:对疑似尾炎的儿童 (≤18岁) 的研究,报告临床数据,并通过病理学或随访确认诊断.
- 包括42项研究的数据提取和质量评估.
主要成果:
- 发烧 (LR 3.4) 和反弹疼痛 (LR 3.0) 是儿童尾炎的重要指标.
- 没有发烧 (LR 0.32) 和反弹疼痛 (LR 0.28) 会降低尾炎的可能性.
- 迁移的腹痛 (LR 1.9-3.1) 和特定的白细胞计数 (WBC <10,000/microL,LR 0.22;绝对中性粒细胞计数 <6750/microL,LR 0.06) 也有助于诊断.
- 症状和症状的组合是最有效的排除尾炎.
结论:
- 临床检查虽然不是最终的,但对于指导手术咨询或进一步诊断儿童尾炎的诊断评估是有价值的.
- 对于诊断儿童尾炎的临床检查的实用性可以通过更多针对儿童的,年龄分层的数据来提高.
- 将临床发现与实验室结果结合起来,可以提高儿科尾炎的诊断准确度.
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