这位咳的青少年或成年患者是否患有 pertussis?
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
概括
在成人和青少年中,百日咳往往是错过的. 咳后吐和鼓舞性声略微增加了 pertussis 的可能性,但临床判断仍然是诊断的关键.
科学领域:
- 传染性疾病 传染性疾病
- 临床诊断 临床诊断 临床诊断
- 公共卫生 公共卫生
背景情况:
- 百日咳 (百日咳) 经常被低估为青少年和成人慢性咳的原因.
- 典型的百日咳症状的诊断价值,如阳性咳,咳后吐和鼓舞性叫,尚未得到充分证实.
研究的目的:
- 系统地审查三种经典 pertussis 症状的诊断实用性:发热性咳,咳后吐和鼓舞性.
- 评估这些症状的证据,以诊断5岁以上的个人,青少年和成年人的百日咳.
主要方法:
- 在MEDLINE和EMBASE数据库 (1966-2010) 中进行了系统的文献搜索.
- 包括的研究涉及咳病患者和使用参考标准确诊的咳诊断.
- 数据提取和分析是由两位作者独立进行的.
主要成果:
- 分析了三个前性研究,涉及5岁以上的患者,青少年和成年人.
- 咳后吐 (LR: 1.8) 或鼓吹性 (LR: 1.9) 的存在增加了 pertussis 的可能性.
- 无发性咳 (LR:0.52) 或咳后吐 (LR:0.58) 降低了这种可能性;缺乏鼓舞性是不那么有信息的 (LR:0.78).
结论:
- 对于经典百日咳症状的诊断价值的证据有限,在非爆发环境中质量较差.
- 咳后的吐和鼓舞性声只会轻微改变 pertussis 的可能性.
- 临床判断对于指导进一步的测试或经验治疗决策至关重要.
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