这个孩子有肺炎吗? : 理性的临床检查系统审查
Sonal N Shah1, Richard G Bachur1, David L Simel2,3
1Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
JAMA
|August 2, 2017
概括
低氧和增加的呼吸是诊断儿童肺炎的关键指标. 虽然常见的症状如发烧和呼吸暂停不太可靠,但这些症状有助于临床医生更准确地识别肺炎.
科学领域:
- 儿童医学
- 诊断的准确性
- 呼吸系统疾病
背景情况:
- 肺炎是儿童疾病和死亡的重要原因.
- 准确的诊断对于预防严重后果和减少过度使用抗生素至关重要.
研究的目的:
- 系统地审查临床症状和体检结果的诊断准确性,以确定儿童的放射性肺炎.
- 评估不同标志的有效性,以区分肺炎与其他儿科呼吸道疾病.
主要方法:
- 通过MEDLINE和Embase搜索发现的23项诊断研究 (13833名儿童) 的系统审查.
- 对症状和发现计算了概率比率,敏感度和特异性,使用胸部X射线透物作为参考标准.
主要成果:
- 没有单一的症状可靠地表明肺炎. 在青少年中,胸部疼痛与中度疼痛有关.
- 发烧和呼吸暂停的诊断价值有限. 中度低氧 (氧和率≤96%) 和增加的呼吸工作是最重要的指标.
- 正常氧化 (氧和率>96%) 降低了肺炎的可能性.
结论:
- 低氧和增加的呼吸工作是儿童肺炎的更关键的指标,而不是短睡或听觉发现.
- 临床评估应优先考虑低氧化和呼吸困难的迹象,以准确诊断儿童的肺炎.
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