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使用初级保健记录识别患有严重慢性病的儿童
Lucy Plumb1,2, Manish D Sinha3, Timothy Jones1,4
1Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom.
在儿童中早期发现慢性病 (CKD) 是具有挑战性的. 虽然某些症状和增加的初级保健访问可能是CKD的信号,但由于这种情况,它们的预测价值是有限的.
科学领域:
- 儿科脏病学 儿科脏病学
- 主要护理医学 医疗保健
- 流行病学 流行病学
背景情况:
- 在初级保健中了解症状报告可以促进儿童早期发现慢性病 (CKD).
- 早期诊断CKD支持预防疾病进展和改善长期结果的干预措施.
研究的目的:
- 为了确定在初级保健中症状/迹象或咨询频率是否预测了随后的儿科CKD诊断.
- 为了确定与儿童严重的CKD相关的特定症状和咨询模式.
主要方法:
- 使用临床实践研究数据链接进行了一项病例控制研究.
- 病例是儿童 (<21岁) 发生严重的CKD (2000-2018);对照组根据年龄,性别和实践测试率进行了匹配.
- 条件后勤回归分析了症状预测因子和诊断前24个月和6个月的咨询频率.
主要成果:
- 诸如生长问题,和尿路感染等症状预测了前24个月严重的CKD.
- 预测值在6个月内增加,但灵敏度下降.
- 患有CKD的儿童的咨询频率更高;综合症状和频率数据显示了适度的歧视 (c-统计值0.70).
结论:
- 尽管症状之间存在关联,诊断增加,以及严重的CKD,但低的积极预测值会使早期诊断复杂化.
- 儿科慢性脏病的罕见性 presents一个诊断挑战,即使确定了预测因素.
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