在初级保健中预测患有下呼吸道感染的儿童的疾病进展:前性队列和观察性研究
Paul Little1, Taeko Becque1, Alastair D Hay2
1Primary Care Population Sciences and Medical Education Unit, University of Southampton, Southampton, UK.
一个新的三项预后得分有效地识别了低风险的下呼吸道感染 (LRTI) 的儿童,有助于临床决策和减少过度使用抗生素.
科学领域:
- 儿科 儿科 儿科
- 传染性疾病 传染性疾病
- 临床预后 临床预后
背景情况:
- 在儿童下呼吸道感染 (LRTI) 中过度使用抗生素有助于抗生素耐药性.
- 预后工具的有限可用性阻碍了儿科LRTIs的有效管理.
研究的目的:
- 通过外部验证STARWAVe预后模型来识别患有LRTIs且疾病进展风险较低的儿童.
- 如果STARWAVe的性能不足,开发和内部验证一个新的预后模型.
主要方法:
- 前性队列研究,在初级保健中进行嵌套随机对照试验.
- 包括6个月至12岁的儿童,没有并发症的LRTIs.
- 在基线收集的临床数据,以预测不良结果 (疾病进展).
主要成果:
- 在STARWAVe模型中,表现适度 (AUROC 0.66).
- 一个新的七项模型显示了良好的歧视 (AUROC 0.83).
- 一个简化的三项模型 (呼吸速率,氧和度,胸部检测结果) 的表现良好 (AUROC 0.81) 和衍生得分 (<70) 确定了89%的患病风险低的儿童.
结论:
- 一个简单的,三项预后得分可以可靠地识别患有低风险不良结果的LRTIs的儿童.
- 这一分数可以指导临床管理,并可能减少不必要的抗生素处方.
- 这些发现支持使用该工具来改善儿科LRTI护理.
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