Working Group on Recognising Acute Illness in Children, Royal College of Paediatrics and Child Health, London, UK.
Arch Dis Child. 2011 Apr;96(4):368-73. doi: 10.1136/adc.2010.183129. Epub 2011 Jan 12.
Distinguishing serious bacterial infection (SBI) from milder/self-limiting infections is often difficult. Interpretation of vital signs is confounded by the effect of temperature on pulse and respiratory rate. Temperature-pulse centile charts have been proposed to improve the predictive value of pulse rate in the clinical assessment of children with suspected SBI.
To assess the utility of proposed temperature-pulse centile charts in the clinical assessment of children with suspected SBI.
The predictive value for SBI of temperature-pulse centile categories, pulse centile categories and Advanced Paediatric Life Support (APLS) defined tachycardia were compared among 1360 children aged 3 months to 10 years presenting with suspected infection to a hospital emergency department (ED) in England; and among 325 children who presented to hospitals in the UK with meningococcal disease.
SBI.
Among children presenting to the ED, 55 (4.0%) had SBI. Pulse centile category, but not temperature-pulse centile category, was strongly associated with risk of SBI (p=0.0005 and 0.288, respectively). APLS defined tachycardia was also strongly associated with SBI (OR 2.90 (95% CI 1.60 to 5.26), p=0.0002). Among children with meningococcal disease, higher pulse and temperature-pulse centile categories were both associated with more severe disease (p=0.004 and 0.041, respectively).
Increased pulse rate is an important predictor of SBI, supporting National Institute for Health and Clinical Excellence recommendations that pulse rate be routinely measured in the assessment of febrile children. Temperature-pulse centile charts performed more poorly than pulse alone in this study. Further studies are required to evaluate their utility in monitoring the clinical progress of sick children over time.
区分严重细菌感染（SBI）与较轻/自限性感染通常较为困难。体温对脉搏和呼吸频率的影响使得生命体征的解读变得复杂。已经提出了温度-脉搏百分位数图表，以提高疑似 SBI 患儿临床评估中脉搏率的预测价值。
评估提出的温度-脉搏百分位数图表在疑似 SBI 患儿临床评估中的应用价值。
本研究比较了英格兰一家医院急诊科（ED）就诊的 1360 名 3 个月至 10 岁疑似感染的儿童和英国 325 名患有脑膜炎球菌病的儿童中，温度-脉搏百分位类别、脉搏百分位类别和高级儿科生命支持（APLS）定义的心动过速对 SBI 的预测价值。
SBI。
在 ED 就诊的儿童中，55 例（4.0%）患有 SBI。脉搏百分位类别与 SBI 风险密切相关（p=0.0005 和 0.288），但温度-脉搏百分位类别并非如此。APLS 定义的心动过速也与 SBI 密切相关（OR 2.90（95%CI 1.60 至 5.26），p=0.0002）。在患有脑膜炎球菌病的儿童中，较高的脉搏和温度-脉搏百分位类别均与更严重的疾病相关（p=0.004 和 0.041）。
脉搏率升高是 SBI 的重要预测因素，支持英国国家卫生与临床优化研究所的建议，即在评估发热儿童时常规测量脉搏率。在这项研究中，温度-脉搏百分位数图表的表现不如单独的脉搏。需要进一步的研究来评估它们在随时间监测患病儿童临床进展方面的效用。
