English Mike, Berkley James, Mwangi Isiah, Mohammed Shebbe, Ahmed Maimuna, Osier Faith, Muturi Neema, Ogutu Bernhards, Marsh Kevin, Newton Charles R J C
Centre for Geographic Medicine Research, Kenya Medical Research Institute/Wellcome Trust Research Laboratories, Kilifi, Kenya.
Bull World Health Organ. 2003;81(3):166-73. Epub 2003 May 16.
To investigate whether the outpatient, syndrome-based approach of the Integrated Management of Childhood Illness (IMCI) protocol could be extended to the inpatient arena to give clear and simple minimum standards of care for poorly resourced facilities.
A prospective, one-year admission cohort retrospectively compared hypothetical performance of syndrome-based management with paediatrician-defined final diagnosis. Admission syndrome definitions were based on local adaptations to the IMCI protocol that encompassed 20 clinical features, measurement of oxygen saturation, and malaria microscopy.
After 315 children with clinically obvious diagnoses (e.g. sickle cell disease and burns) were excluded, 3705 admission episodes were studied. Of these, 2334 (63%) met criteria for at least one severe syndrome (mortality 8% vs <1% for "non-severe" cases), and half of these had features of two or more severe syndromes. No cases of measles were seen. Syndrome-based treatment would have been appropriate (sensitivity >95%) for severe pneumonia, severe malaria, and diarrhoea with severe dehydration, and probably for severe malnutrition (sensitivity 71%). Syndrome-directed treatment suggested the use of broad-spectrum antibiotics in 75/133 (56% sensitivity) children with bacteraemic and 63/71 (89% sensitivity) children with meningitis.
Twenty clinical features, oxygen saturation measurements, and results of malaria blood slides could be used for inpatient, syndrome-based management of acute paediatric admissions. The addition of microscopy of the cerebrospinal fluid and haemoglobin measurements would improve syndrome-directed treatment considerably. This approach might rationalize admission policy and standardize inpatient paediatric care in resource-poor countries, although the clinical detection of bacteraemia remains a problem.
探讨儿童疾病综合管理（IMCI）方案中基于综合征的门诊治疗方法是否可扩展至住院治疗领域，以为资源匮乏的医疗机构提供明确且简单的最低护理标准。
一项为期一年的前瞻性入院队列研究，回顾性比较基于综合征的管理与儿科医生确定的最终诊断的假设表现。入院综合征定义基于对IMCI方案的本地化调整，涵盖20项临床特征、血氧饱和度测量和疟疾显微镜检查。
排除315例临床诊断明确的儿童（如镰状细胞病和烧伤）后，对3705次入院病例进行了研究。其中，2334例（63%）符合至少一种严重综合征的标准（死亡率8%，而“非严重”病例为<1%），其中一半具有两种或更多种严重综合征的特征。未发现麻疹病例。基于综合征的治疗对于重症肺炎、重症疟疾和伴有严重脱水的腹泻可能是合适的（敏感性>95%），对于重度营养不良可能也是合适的（敏感性71%）。针对综合征的治疗建议对75/133例（敏感性56%）菌血症儿童和63/71例（敏感性89%）脑膜炎儿童使用广谱抗生素。
20项临床特征、血氧饱和度测量和疟疾血涂片结果可用于急性儿科住院患者基于综合征的管理。增加脑脊液显微镜检查和血红蛋白测量将显著改善针对综合征的治疗。这种方法可能使资源匮乏国家的入院政策合理化，并规范住院儿科护理，尽管菌血症的临床检测仍然是一个问题。
