Mulholland E K, Simoes E A, Costales M O, McGrath E J, Manalac E M, Gove S
MRC Laboratories, Banjul, The Gambia.
Pediatr Infect Dis J. 1992 Feb;11(2):77-81. doi: 10.1097/00006454-199202000-00004.
The World Health Organization recommends the use of raised respiratory rate and chest wall indrawing to enable health workers in developing countries to diagnose pneumonia. We evaluated the current World Health Organization guidelines for management of the child with cough or difficult breathing in Manila, Philippines and Mbabane, Swaziland using an identical protocol in both countries. Raised respiratory rate was defined as greater than or equal to 50/minute for children ages 2 to 12 months and greater than or equal to 40/minute for children 12 months to 5 years. Chest wall indrawing was defined as inward movement of the bony structures of the lower chest wall with inspiration. In the Philippines raised respiratory rate or chest wall indrawing, when applied by a pediatrician, was found to have a sensitivity of 0.81 and specificity of 0.77 for predicting pneumonia as determined by a pediatrician with the aid of a chest roentgenogram. In Swaziland the sensitivity was 0.77 and the specificity was 0.80. When applied by health workers the sensitivity was similar but the specificity was lower. The current World Health Organization ARI case management guidelines predicted pneumonia with similar sensitivity and specificity in two very different developing countries, the Philippines and Swaziland.
世界卫生组织建议采用呼吸频率加快和胸壁凹陷来帮助发展中国家的卫生工作者诊断肺炎。我们在菲律宾的马尼拉和斯威士兰的姆巴巴内，使用相同的方案对当前世界卫生组织关于咳嗽或呼吸困难儿童的管理指南进行了评估。呼吸频率加快的定义为：2至12个月大的儿童每分钟呼吸次数大于或等于50次，12个月至5岁的儿童每分钟呼吸次数大于或等于40次。胸壁凹陷的定义为吸气时下胸壁骨骼结构向内移动。在菲律宾，由儿科医生应用呼吸频率加快或胸壁凹陷来预测肺炎时，其敏感性为0.81，特异性为0.77，这是由一名儿科医生借助胸部X光片确定的。在斯威士兰，敏感性为0.77，特异性为0.80。当由卫生工作者应用时，敏感性相似，但特异性较低。当前世界卫生组织的急性呼吸道感染病例管理指南在两个非常不同的发展中国家——菲律宾和斯威士兰，以相似的敏感性和特异性预测肺炎。
