理性的临床检查. 这个婴儿有肺炎吗?
1Division of Community Pediatrics, The University of North Carolina at Chapel Hill, 27599-7225, USA. margolis@med.unc.edu
JAMA
|February 5, 1998
概括
临床检查可以准确检测儿童的肺炎. 没有快速呼吸是排除肺炎的最佳迹象,而呼吸困难的迹象增加了肺炎的可能性.
科学领域:
- 儿科 儿科 儿科
- 肺部病理学 肺部病理学
- 诊断的准确性 诊断的准确性
背景情况:
- 急性下呼吸道疾病常见于向初级保健提供儿童.
- 区分病毒和细菌性肺炎对于适当的治疗至关重要.
- 儿科肺炎临床检查结果的准确性需要彻底评估.
研究的目的:
- 审查临床检查在诊断儿童肺炎的准确性和精确性.
- 为了确定儿童肺炎的关键临床迹象.
- 在初级保健机构评估临床发现的可靠性.
主要方法:
- 对1982年至1995年间发表的研究进行系统审查.
- 纳入标准包括对儿科肺炎临床检查的研究.
- 数据提取和质量评估由两个独立观察员进行.
主要成果:
- 对于大多数可观察的迹象 (例如,辅助肌肉使用,颜色,注意力) 发现了良好的观察者协议.
- 对听觉发现 (例如,偶然的声音) 的一致性较低.
- 缺陷呼吸暂停是排除肺炎的最强有力的指标;增加的呼吸工作表明肺炎.
结论:
- 临床检查对于诊断儿科肺炎是有价值的,特定的迹象比其他更可靠.
- 负面的临床评估 (呼吸率,听觉,呼吸工作) 使肺炎不太可能发生.
- 需要进一步的研究来评估临床发现在诊断儿科肺炎方面的综合实用性.
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