Lynch Tim, Platt Robert, Gouin Serge, Larson Charles, Patenaude Yves
Department of Pediatrics, Children's Hospital of Western Ontario, London, Ontario, Canada.
Pediatrics. 2004 Mar;113(3 Pt 1):e186-9. doi: 10.1542/peds.113.3.e186.
To determine predictive factors for the presence of focal infiltrates in children with clinically suspected pneumonia in a pediatric emergency department.
Children (1-16 years) with clinically suspected pneumonia were studied prospectively. The presenting features were compared between the children with and without focal infiltrates using chi2 analysis, t test, and odds ratio with 95% confidence intervals. A multivariate prediction rule was developed using logistic regression.
A total of 570 were studied. Risk factors (odds ratio; 95% confidence interval) for the presence of focal infiltrates included history of fever (3.1; 1.7-5.3), decreased breath sounds (1.4; 1.0-2.0), crackles (2.0; 1.4-2.9), retractions (2.8; 1.0-7.6), grunting (7.3; 1.1-48.1), fever (1.5; 1.2-1.9), tachypnea (1.8; 1.3-2.5), and tachycardia (1.3; 1.0-1.6). We then used logistic regression to develop a candidate prediction rule for the variables of fever, decreased breath sounds, crackles, and tachypnea, which had an area under the receiver operating curve of 0.668. This rule had excellent sensitivity (93.1%-98%) yet poor specificity (5.7%-19.4%).
Multiple predictive factors for children with suspected pneumonia have been identified. Patients with focal infiltrates were more likely in our study to have a history of fever, tachypnea, increased heart rate, retractions, grunting, crackles, or decreased breath sounds. A multivariate prediction rule shows promise for the accurate prediction of pneumonia in children. However, the prospective evaluation of this multivariate prediction rule in a clinical setting is still required.
确定儿科急诊科临床疑似肺炎患儿出现局灶性浸润的预测因素。
对临床疑似肺炎的1 - 16岁儿童进行前瞻性研究。采用卡方分析、t检验以及95%置信区间的比值比，比较有和无局灶性浸润患儿的临床表现。使用逻辑回归建立多变量预测规则。
共研究了570例患儿。出现局灶性浸润的危险因素（比值比；95%置信区间）包括发热史（3.1；1.7 - 5.3）、呼吸音减弱（1.4；1.0 - 2.0）、湿啰音（2.0；1.4 - 2.9）、吸气三凹征（2.8；1.0 - 7.6）、呻吟声（7.3；1.1 - 48.1）、发热（1.5；1.2 - 1.9）、呼吸急促（1.8；1.3 - 2.5）以及心动过速（1.3；1.0 - 1.6）。然后我们使用逻辑回归为发热、呼吸音减弱、湿啰音和呼吸急促这些变量建立了一个候选预测规则，其受试者工作特征曲线下面积为0.668。该规则具有出色的敏感性（93.1% - 98%）但特异性较差（5.7% - 19.4%）。
已确定疑似肺炎患儿的多个预测因素。在我们的研究中，有局灶性浸润的患者更可能有发热史、呼吸急促、心率加快、吸气三凹征、呻吟声、湿啰音或呼吸音减弱。多变量预测规则有望准确预测儿童肺炎。然而，仍需要在临床环境中对该多变量预测规则进行前瞻性评估。
