婴儿结果,风险因素和诊断收益率在一个简短的解决不明原因事件后:系统性审查和元分析
Nassr Nama1, Stephanie Liebert1, Mario Abaji2
1Department of Pediatrics, Division of Hospital Medicine, University of Washington School of Medicine, Seattle Children's Hospital, Seattle.
JAMA pediatrics
|January 26, 2026
概括
婴儿的简短解决不明原因事件 (BRUE) 很少导致严重的诊断或死亡. 大多数例行检查的价值很小,建议转向基于风险的临床方法,以更好地照顾婴儿.
科学领域:
- 儿科急救医学 儿科急救医学
- 新生儿科学 新生儿科学
- 临床流行病学 临床流行病学
背景情况:
- 由于研究有限,临床不确定性仍然存在于短暂解决的不明原因事件 (BRUE) 上.
- 临床实践中的差异源于关于不良结果,危险因素和诊断效用的相互矛盾的数据.
研究的目的:
- 为了确定严重的潜在诊断的频率和婴儿在BRUE后的3个月死亡率.
- 为了确定不良结果的预后风险因素.
- 量化BRUE常见调查的诊断产量.
主要方法:
- 对队列研究,病例控制研究和临床试验进行系统审查和元分析.
- 在PubMed,Embase,Cochrane和灰色文献中进行了搜索 (2016年1月至2025年7月).
- 使用随机效应元分析汇集流行率,死亡率,风险因素和诊断产量;用GRADE评估证据确定性.
主要成果:
- 分析了包括6603名婴儿在内的24项研究.
- 严重的潜在诊断患病率为6.0% (高确定性);3个月死亡率很少 (1在1851名婴儿中,中等确定性).
- 多重事件史和早产增加了严重诊断的风险;例行测试 (代谢面板,心电图,胸部X射线) 显示了非常低的诊断产量.
结论:
- 在BRUE后的婴儿死亡率极为罕见,很少有严重的潜在诊断.
- 大多数常规诊断测试提供最小的价值,并且可以产生错误的阳性结果.
- 临床实践应该过渡到针对BRUE的有针对性的,基于风险的评估,指导指南的修订.
相关概念视频
Factors Affecting the Risk of Infection
13.3K
The hosts' susceptibility to infection depends on several factors. The integrity of the skin and mucous membranes helps protect the body against microbial attacks. When the skin is altered, the chance of infection, limb loss, and even death increases.
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
13.3K
ATP Yield
78.4K
Cellular respiration produces 30 - 32 ATP per glucose molecule. Although most of the ATP results from oxidative phosphorylation and the electron transport chain (ETC), 4 ATP are gained beforehand (2 from glycolysis and 2 from the citric acid cycle).
The ETC is embedded in the inner mitochondrial membrane and is comprised of four main protein complexes and an ATP synthase. NADH and FADH2 pass electrons to these complexes, which pump protons into the intermembrane space. This distribution of...
The ETC is embedded in the inner mitochondrial membrane and is comprised of four main protein complexes and an ATP synthase. NADH and FADH2 pass electrons to these complexes, which pump protons into the intermembrane space. This distribution of...
78.4K
Reaction Yield
59.4K
The theoretical yield of a reaction is the amount of product estimated to form based on the stoichiometry of the balanced chemical equation. The theoretical yield assumes the complete conversion of the limiting reactant into the desired product. The amount of product that is obtained by performing the reaction is called the actual yield, and it may be less than or (very rarely) equal to the theoretical yield.
59.4K
Review and Preview
8.3K
In statistics, several tools are used to interpret the data. Measures of central tendency represent the characteristics of the data, such as mean, median, and mode. Additionally, measures of variance like standard deviation and range are used to find the spread of data from the mean. Relative standing measures the distance between data locations. Commonly used measures of relative standings are percentile, z score, and quartiles.
Percentiles are a type of fractile that partition data into...
Percentiles are a type of fractile that partition data into...
8.3K
Review and Preview
10.9K
Data are individual items of information obtained from a population or sample. Data may be classified as qualitative (categorical), quantitative continuous, or quantitative discrete. Because it is not practical to measure the entire population in a study, researchers use samples to represent the population. A random sample is a representative group from the population chosen by using a method that gives each individual in the population an equal chance of being included in the sample. Random...
10.9K
Random and Systematic Errors
14.7K
Scientists always try their best to record measurements with the utmost accuracy and precision. However, sometimes errors do occur. These errors can be random or systematic. Random errors are observed due to the inconsistency or fluctuation in the measurement process, or variations in the quantity itself that is being measured. Such errors fluctuate from being greater than or less than the true value in repeated measurements. Consider a scientist measuring the length of an earthworm using a...
14.7K


