Kudawla Meenakshi, Dutta Sourabh, Narang Anil
Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
J Trop Pediatr. 2008 Feb;54(1):66-9. doi: 10.1093/tropej/fmm065. Epub 2007 Aug 14.
There is paucity of data about the predictive values and likelihood ratios of clinical signs of late onset nosocomial sepsis in neonates. A clinical score comprising of seven items had been derived from analysis of individual signs and had been published by this group in the Journal of Tropical Pediatrics in 2003. The current study was done to validate the score in a fresh validation cohort, to evaluate the score at 0 and 24 h after onset of clinical signs of sepsis and to evaluate the sepsis screen in combination with the clinical score. The seven clinical signs in the clinical score included grunting, abdominal distension, increased prefeed aspirates, tachycardia, hyperthermia, chest retractions and lethargy. A total of 220 episodes of sepsis among 208 babies were evaluated. The clinical score was calculated at 0 h and 24 h. A sepsis screen (micro erythrocyte sedimentation rate, C reactive protein, absolute neutrophil count and immature/total neutrophil ratio) and blood culture were performed in all subjects at enrollment. Sepsis screen was considered 'positive' if any two parameters were positive. The outcome of interest was 'definite sepsis', defined as blood culture positive. The 0-h clinical score had sensitivity, specificity, PPV, NPV, LR(+) and LR(-) of 90, 22.5, 30.3, 85.7, 1.16 and 0.44%, respectively. The 24-h score had higher specificity (60.6%) but lower sensitivity than the 0-h score. Sepsis screen per se had a sensitivity and NPV of 48.3 and 78.3% but when combined with the 0-h clinical score, the sensitivity and NPV rose to 95 and 90.6%, respectively. The 'clinical score' in combination with sepsis screen result can be used by clinicians to rule out sepsis.
关于新生儿晚发性医院感染性败血症临床体征的预测价值和似然比的数据匮乏。通过对个体体征的分析得出了一个包含七个项目的临床评分,该评分由该团队于2003年发表在《热带儿科学杂志》上。本研究旨在在一个新的验证队列中验证该评分,评估败血症临床体征出现后0小时和24小时的评分,并结合临床评分评估败血症筛查。临床评分中的七个临床体征包括呻吟、腹胀、喂奶前抽吸物增加、心动过速、体温过高、胸部凹陷和嗜睡。对208名婴儿中的220次败血症发作进行了评估。在0小时和24小时计算临床评分。所有受试者在入组时均进行了败血症筛查(微量红细胞沉降率、C反应蛋白、绝对中性粒细胞计数和未成熟/总中性粒细胞比率)和血培养。如果任何两个参数呈阳性,则败血症筛查被视为“阳性”。感兴趣的结果是“确诊败血症”,定义为血培养阳性。0小时临床评分的敏感性、特异性、阳性预测值、阴性预测值、阳性似然比和阴性似然比分别为90%、22.5%、30.3%、85.7%、1.16和0.44%。24小时评分的特异性较高(60.6%),但敏感性低于0小时评分。败血症筛查本身的敏感性和阴性预测值分别为48.3%和78.3%,但与0小时临床评分相结合时,敏感性和阴性预测值分别升至95%和90.6%。临床医生可以使用“临床评分”结合败血症筛查结果来排除败血症。