Yurdakök Kadriye, Güner Sükrü N, Yalçin S Songül
Institute of Child Health, Hacettepe University, Ankara, Turkey.
Pediatr Int. 2008 Apr;50(2):232-4. doi: 10.1111/j.1442-200X.2008.02565.x.
The World Health Organization recommends the assessment of pallor as an indicator for the presence of anemia in children under 5 years of age at a primary care level where anemia is prevalent. The aim of the present study was to study the validity and interobserver agreement of pallor examination in recognition of anemia in children under 2 years of age.
Healthy children aged 6-24 months (n = 141) admitted to well baby clinic were assessed for the presence of pallor at three anatomic sites (palm, conjunctiva, buccal mucosa) on admission by two blinded observers (Integrated Management of Childhood Illness [IMCI] certificate pediatrician and a pediatric resident). Clinical examination for pallor was made without having the information on the child's hemoglobin level or of the other observer's assessment for pallor. Anemia was defined as hemoglobin level <11 g/dL. The exclusion criteria included the presence of any acute or chronic illness on admission, and treatment for anemia within the 3 months preceding the study.
The mean age of the children was 8.0 +/- 2.7 months; 71 (50%) were boys. Blood samples indicated anemia in 33 children (23%). Palmar pallor alone significantly had highest sensitivity (sensitivity 72% and specificity 75%, positive predictive value 48%) to detect anemia for the IMCI-trained pediatrician. The interobserver agreement was highest for buccal and conjunctival pallor (kappa = 0.64 and 0.63, respectively), and lowest for palmar pallor (kappa = 0.49).
Palmar pallor is a sensitive and specific sign of mild anemia when used by the IMCI-trained pediatrician.
世界卫生组织建议，在贫血普遍存在的初级保健层面，将面色苍白评估作为5岁以下儿童贫血存在情况的指标。本研究的目的是研究面色苍白检查在识别2岁以下儿童贫血方面的有效性和观察者间一致性。
在一家母婴健康诊所就诊的141名6至24个月的健康儿童，由两名不知情的观察者（持有儿童疾病综合管理[IMCI]证书的儿科医生和一名儿科住院医师）在入院时对三个解剖部位（手掌、结膜、颊黏膜）进行面色苍白评估。在不知道儿童血红蛋白水平或其他观察者面色苍白评估信息的情况下进行面色苍白的临床检查。贫血定义为血红蛋白水平<11 g/dL。排除标准包括入院时存在任何急性或慢性疾病，以及在研究前3个月内接受过贫血治疗。
儿童的平均年龄为8.0±2.7个月；71名（50%）为男孩。血液样本显示33名儿童（23%）贫血。仅手掌苍白对经过IMCI培训的儿科医生检测贫血具有显著最高的敏感性（敏感性72%，特异性75%，阳性预测值48%）。观察者间一致性在颊黏膜和结膜苍白方面最高（kappa分别为0.64和0.63），在手掌苍白方面最低（kappa为0.49）。
经过IMCI培训的儿科医生使用时，手掌苍白是轻度贫血的敏感且特异体征。
