Michelfelder Erik C, Ochsner Jennifer E, Khoury Philip, Kimball Thomas R
Division of Cardiology, Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
J Pediatr. 2003 Mar;142(3):263-7. doi: 10.1067/mpd.2003.42.
To compare the yield rate (YR) of echocardiography when evaluating children with suspected infectious endocarditis (IE) in both the actual clinical setting and in the hypothetic setting where strict clinical criteria are applied. Study design Medical records of 101 children undergoing echocardiography for suspected IE were reviewed. Echocardiograms with positive findings were identified and the actual diagnostic YR was calculated. With the use of clinical criteria proposed by von Reyn (VR), the probability of IE was retrospectively classified as (1) rejected, (2) possible, or (3) probable. Theoretic YR of echocardiography was calculated for each classification.
The actual YR of echocardiography was 12% (12/101). The YR of echocardiography by VR class was 0% in rejected, 20% in possible, and 80% in probable cases (chi(2) = 55.1, P <.0001). Echocardiography did not change the probability of IE in any patient classified as rejected, but allowed reassignment of disease probability in a significant proportion of patients with possible or probable IE.
The YR of echocardiography was significant when clinical probability of IE was intermediate-to-high, and low, with marginal clinical utility, when clinical probability was low. Strict pretest assessment of disease probability may lead to more effective utilization of echocardiography in this population.
比较在实际临床环境以及应用严格临床标准的假设环境中，超声心动图评估疑似感染性心内膜炎（IE）儿童时的检出率（YR）。研究设计回顾了101例因疑似IE接受超声心动图检查的儿童的病历。确定有阳性发现的超声心动图，并计算实际诊断检出率。使用冯·雷诺（VR）提出的临床标准，将IE的可能性回顾性分类为：（1）排除，（2）可能，或（3）很可能。计算每种分类的超声心动图理论检出率。
超声心动图的实际检出率为12%（12/101）。根据VR分类，超声心动图的检出率在排除病例中为0%，在可能病例中为20%，在很可能病例中为80%（χ² = 55.1，P <.0001）。超声心动图并未改变任何被分类为排除的患者患IE的可能性，但在很大比例的可能或很可能患IE的患者中，可重新确定疾病可能性。
当IE的临床可能性为中到高时，超声心动图的检出率较高；而当临床可能性较低时，其检出率较低，临床效用有限。对疾病可能性进行严格的预测试评估可能会使该人群更有效地利用超声心动图。
