这个咳嗽的青少年或成年患者是否患有百日咳？

Does this coughing adolescent or adult patient have pertussis?

机构信息

Primary and Specialty Medical Care Service, Veterans Affairs Puget Sound Health Care System, and Department of Medicine, University of Washington School of Medicine, Seattle, USA.

出版信息

JAMA. 2010 Aug 25;304(8):890-6. doi: 10.1001/jama.2010.1181.

DOI:10.1001/jama.2010.1181

PMID:20736473

Abstract

CONTEXT

Pertussis is often overlooked as a cause of chronic cough, especially in adolescents and adults. Several symptoms are classically thought to be suggestive of pertussis, but the diagnostic value of each of them is uncertain.

OBJECTIVE

To systematically review the evidence regarding the diagnostic value of 3 classically described symptoms of pertussis: paroxysmal cough, posttussive emesis, and inspiratory whoop.

DATA SOURCES, STUDY SELECTION, AND DATA EXTRACTION: We searched MEDLINE (January 1966-April 2010), EMBASE (January 1969 to April 2010), and the bibliographies of pertinent articles to identify relevant English-language studies. Articles were selected that included children older than 5 years, adolescents, or adults and confirmed the diagnosis of pertussis among patients with cough illness (of any duration) with an a priori-defined accepted reference standard. Two authors independently extracted data from articles that met selection criteria and resolved any discrepancies by consensus.

DATA SYNTHESIS

Five prospective studies met inclusion criteria; 3 were used in the analysis. Presence of posttussive emesis (summary likelihood ratio [LR], 1.8; 95% confidence interval [CI], 1.4-2.2) or inspiratory whoop (summary LR, 1.9; 95% CI, 1.4-2.6) increases the likelihood of pertussis. Absence of paroxysmal cough (summary LR, 0.52; 95% CI, 0.27-1.0) or posttussive emesis (summary LR, 0.58; 95% CI, 0.44-0.77) reduced the likelihood. Absence of inspiratory whoop was less useful (summary LR, 0.78; 95% CI, 0.66-0.93). No studies evaluated combinations of findings.

CONCLUSIONS

In a nonoutbreak setting, data to determine the diagnostic usefulness of symptoms classically associated with pertussis are limited and of relatively weak quality. The presence or absence of posttussive emesis or inspiratory whoop modestly change the likelihood of pertussis; therefore, clinicians must use their overall clinical impression to decide about additional testing or empirical treatment.

摘要

背景

百日咳常被忽视为慢性咳嗽的病因，尤其是在青少年和成人中。有几个经典症状被认为提示百日咳，但它们各自的诊断价值并不确定。

目的

系统评价 3 种经典描述的百日咳症状（阵发性咳嗽、咳嗽后呕吐和吸气性哮鸣）的诊断价值的证据。

数据来源、研究选择和数据提取：我们检索了 MEDLINE（1966 年 1 月至 2010 年 4 月）、EMBASE（1969 年 1 月至 2010 年 4 月）和相关文章的参考文献，以确定有关儿童（5 岁以上）、青少年或成人咳嗽（任何持续时间）患者的英语研究。选择符合纳入标准的文章，使用预先定义的公认参考标准确诊为百日咳。两名作者独立提取符合选择标准的文章的数据，并通过协商解决任何分歧。

数据综合

符合纳入标准的前瞻性研究有 5 项，其中 3 项纳入分析。咳嗽后呕吐（汇总似然比 [LR]，1.8；95%置信区间 [CI]，1.4-2.2）或吸气性哮鸣（汇总 LR，1.9；95% CI，1.4-2.6）的存在增加了百日咳的可能性。无阵发性咳嗽（汇总 LR，0.52；95% CI，0.27-1.0）或咳嗽后呕吐（汇总 LR，0.58；95% CI，0.44-0.77）的可能性降低。吸气性哮鸣的可能性降低程度较小（汇总 LR，0.78；95% CI，0.66-0.93）。没有研究评估这些表现的组合。