Tebruegge Marc, Misra Indranil, Pantazidou Anastasia, Padhye Amruta, Maity Sarmistha, Dwarakanathan Buvana, Donath Susan, Curtis Nigel, Nerminathan Veerasingham
Department of Paediatrics, Southend University Hospital, Southend-on-Sea, Essex, United Kingdom.
Pediatrics. 2009 Oct;124(4):e729-36. doi: 10.1542/peds.2009-0592. Epub 2009 Sep 28.
Hematemesis and hematochezia are not uncommon presenting complaints in children. The amount of blood loss reported by the parent is likely to influence the pediatrician's decision regarding investigations and management. Currently, there are only very limited data regarding the ability of laypersons to estimate blood losses visually. This study investigated the accuracy of parents, in comparison to pediatric health care professionals, in estimating blood loss volumes.
We performed a prospective, single-blinded study including 227 participants, comprising 131 parents, 58 nurses, and 38 doctors. Participants visually estimated the volume of 1 randomly allocated sample from each of the 2 categories: (1) 1, 5, or 10 mL of artificial blood applied to a diaper (simulated hematochezia) and (2) 5, 10, or 50 mL placed in a kidney-dish (simulated hematemesis). An "error factor" (=, estimated volume/actual volume shown) was used to facilitate comparisons.
Parents provided the most inaccurate estimates overall, although individual accuracy varied considerably. The largest overestimate (518 mL) and the highest error factor (23.4) were recorded in a parent; overall, 71% of the estimates provided by parents were overestimates. The highest proportion of accurate estimates (+/-50% of actual volume) was recorded by nurses (29%). Doctors had a tendency to underestimate volumes (62% of the estimates were less than half the actual volume). However, there was no statistically significant difference between the performance of nurses and doctors. Health care professionals tended to overestimate small volumes and underestimate large volumes. Professional experience had no relevant impact on accuracy, nor did parental gender or age.
Visual estimation of blood losses is highly inaccurate, both by laypersons and by health care professionals. Physicians should, therefore, base management decisions primarily on clinical findings and not overly rely on the history provided, or their own estimates.
呕血和便血是儿童常见的就诊主诉。家长报告的失血量可能会影响儿科医生关于检查和治疗的决策。目前，关于外行人视觉估计失血量能力的数据非常有限。本研究调查了家长与儿科医疗保健专业人员在估计失血量方面的准确性。
我们进行了一项前瞻性、单盲研究，共纳入227名参与者，包括131名家长、58名护士和38名医生。参与者对从以下2类中随机分配的1个样本的量进行视觉估计：（1）将1、5或10毫升人造血液涂抹在尿布上（模拟便血）；（2）将5、10或50毫升放置在肾形盘内（模拟呕血）。使用“误差因子”（=估计量/显示的实际量）来便于比较。
总体而言，家长的估计最不准确，尽管个体准确性差异很大。一名家长的估计高估最多（518毫升），误差因子最高（23.4）；总体而言，家长提供的估计中有71%是高估。护士记录的准确估计比例最高（在实际量的±50%范围内）（29%）。医生倾向于低估出血量（62%的估计小于实际量的一半）。然而，护士和医生的表现之间没有统计学上的显著差异。医疗保健专业人员倾向于高估少量出血而低估大量出血。专业经验对准确性没有相关影响，家长的性别或年龄也没有影响。
外行人以及医疗保健专业人员对失血量的视觉估计都极不准确。因此，医生应主要根据临床发现做出治疗决策，而不应过度依赖所提供的病史或他们自己的估计。
