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两种临床预测工具为儿童快速结核病治疗决策提供信息
Meredith B Brooks1,2, Hamidah Hussain3, Sara Siddiqui2,4
1Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA.
Open forum infectious diseases
|June 23, 2023
概括
两个新的临床预测工具准确地识别了需要快速结核病 (TB) 治疗的儿童,当细菌学确认无法获得时. 这些工具利用临床证据指导及时诊断和管理儿科结核病病例.
科学领域:
- 儿童传染病 儿童传染病
- 临床诊断 临床诊断 临床诊断
- 流行病学 流行病学
背景情况:
- 在儿童中诊断结核病 (TB) 往往缺乏细菌学证据.
- 临床证据被用来启动治疗,但充分性标准尚不清楚.
- 需要工具来识别受益于快速结核病治疗的儿童.
研究的目的:
- 开发和验证用于启动儿童结核病治疗的临床预测工具.
- 确定儿童群体结核病诊断的关键临床预测因素.
主要方法:
- 在巴基斯坦 (2014-2016) 进行潜在的结核病患者寻找干预的二次分析.
- 开发两个工具:分类和回归树 (CART) 决策树和多变量物流回归风险评分.
- 分析包括细菌学证实和临床诊断的结核病例.
主要成果:
- 卡特分析强调了异常的胸部放射和家族结核病史作为关键预测因素 (AUC,0.949).
- 预测得分模型包括年龄,体重低,咳,发烧,体重减轻,暗示性胸部放射和家族病史 (AUC,0.985在截止点9).
- 根据临床标准,很大一部分儿童有资格接受结核病治疗.
结论:
- 临床证据足以准确识别需要结核病治疗的儿童.
- 与现有算法相比,开发的工具表现出强的性能.
- 建议在这些诊断工具投入使用之前进行外部验证.
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