Leal Luciana Pedrosa, Osório Mônica Maria
Departamento de Nutrição, Universidade Federal de Pernambuco, Recife, Brazil.
Cad Saude Publica. 2005 Mar-Apr;21(2):565-72. doi: 10.1590/s0102-311x2005000200023. Epub 2005 Mar 21.
This study aimed to assess the validity and reproducibility of clinical signs (palmar and conjunctival pallor) in the diagnosis of anemia in children 6-23 months of age in Northeast Brazil. This was a cross-sectional study with a sample of 421 children in the child care and pediatric outpatient wards at the Mother and Child Care Institute of Pernambuco. Two examiners evaluated clinical signs using the Kappa coefficient, and validation (sensitivity and specificity) was performed using hemoglobin as the standard. Clinical signs demonstrated low reproducibility (kappa 0.24-0.25). The highest sensitivity for diagnosing anemia (Hb < 11 g/dl) and moderate/ severe anemia (Hb < 9 g/dl), respectively, was provided by combining palmar and conjunctival pallor (39.7% and 53.5%), followed by palmar pallor alone (29.9% and 40.0%). The highest specificity was provided by palmar pallor in the child as compared to the mother (95.5% and 90.1%, Hb < 11 g/dl and Hb < 9 g/dl, respectively). Sensitivity of clinical signs was better in diagnosing moderate/severe anemia, especially when combining palmar and conjunctival pallor, suggesting that their utilization does not provide a good instrument for diagnosing mild anemia.
本研究旨在评估临床体征（手掌苍白和结膜苍白）在诊断巴西东北部6至23个月大儿童贫血方面的有效性和可重复性。这是一项横断面研究，样本来自伯南布哥州妇幼保健研究所儿童保健和儿科门诊病房的421名儿童。两名检查人员使用kappa系数评估临床体征，并以血红蛋白作为标准进行有效性验证（敏感性和特异性）。临床体征显示出较低的可重复性（kappa值为0.24 - 0.25）。诊断贫血（血红蛋白<11 g/dl）和中度/重度贫血（血红蛋白<9 g/dl）时，手掌苍白和结膜苍白相结合的敏感性最高，分别为39.7%和53.5%，其次是单独的手掌苍白，分别为29.9%和40.0%。与母亲相比，儿童手掌苍白的特异性最高（血红蛋白<11 g/dl和血红蛋白<9 g/dl时分别为95.5%和90.1%）。临床体征在诊断中度/重度贫血时的敏感性更好，尤其是手掌苍白和结膜苍白相结合时，这表明使用这些体征不能很好地诊断轻度贫血。
