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临床预测规则的比较在学龄前儿童中,由于不同的病原体而导致的感染性关节炎

Nienke N Hagedoorn¹, Laudi Olijve¹, Laurant Kang²

¹Department of Paediatrics, University of Otago, Christchurch, New Zealand.

Journal of pediatric orthopedics

|May 30, 2023

概括

对于败血性关节炎的临床预测规则显示,对金氏菌和金黄色葡萄球菌感染的表现类似. 然而,这些规则缺乏敏感性,无法排除患有部疼痛的幼儿的败血性关节炎.

科学领域:

儿科整形外科儿科整形外科
传染性疾病传染性疾病
诊断的准确性诊断的准确性

背景情况:

在儿童中区分过渡性肌炎和关节炎是临床上具有挑战性的.
像科赫标准 (KC) 这样的临床预测规则有助于诊断,但它们对像金氏菌 (Kingella Kingae) 这样的不那么致命的病原体的疗效尚不清楚.
这项研究评估了预测规则在学龄前儿童的表现,这些儿童患有由不同的病原体引起的败血性关节炎.

研究的目的:

为了确定Kocher标准 (KC) 和修改后的KC在诊断由Kingella Kingae引起的败血性关节炎中的性能,与Staphylococcus aureus相比.
为了评估KC得分是否在金格拉金盖氏菌性关节炎中较低.
评估这些标准对学龄前儿童的敏感性.

主要方法:

回顾性多中心研究 (澳大利亚和新西兰,2012年至2016年).
包括因S. aureus (n=29),K. kingae (n=20),其他病原体 (n=32) 和未发现病原体 (n=48) 引起的败血性关节炎的儿童.
应用KC (温度,承重,ESR,WBC) 和修改的KC (添加CRP),评估KC≥3和mKC≥4的切割值的灵敏度.

主要成果:

在K. kingae和S. aureus感染之间,KC和修改的KC得分没有显著差异 (P=0.27,P=0.21).
对KC和修改KC的敏感性与K. kingae (60.0%) 和S. aureus (62.1%) 的敏感性相似.
使用KC或修改后的KC治疗的败血性关节炎的总体敏感度为56.6% (95%CI 47.6-65.3).

结论:

临床预测规则表明金氏菌和黄金杆菌菌性关节炎的诊断性能相似.
不到60%的已确诊的关节炎的儿童达到预测规则的切断值.
这些预测规则表现出缺乏足够的灵敏度,以可靠地排除在学前儿童呈现急性关节疼痛时的败血性关节炎.

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