Department of Primary Health Care, Oxford University, Rosemary Rue Building, Old Road Campus, Headington, Oxford OX3 7LF, UK.
Arch Dis Child. 2011 Aug;96(8):708-14. doi: 10.1136/adc.2010.206243. Epub 2011 May 17.
Parent-reported symptoms are frequently used to triage children, but little is known about which symptoms identify children with serious respiratory infections. The authors aimed to identify symptoms and triage findings predictive of serious respiratory infection, and to quantify agreement between parent and nurse assessment.
Prospective diagnostic cohort study.
Paediatric Assessment Unit, University Hospitals Coventry and Warwickshire NHS Trust.
535 children aged between 3 months and 12 years with suspected acute infection.
Parents completed a symptom questionnaire on arrival. Children were triaged by a nurse, who measured routine vital signs. The final diagnosis at discharge was used as the outcome. Symptoms and triage findings were analysed to identify features diagnostic of serious respiratory infection. Agreement between parent and triage nurse assessment was measured and kappa values calculated.
Parent-reported symptoms were poor indicators of serious respiratory infection (positive likelihood ratio (LR+) 0.56-1.93) and agreed poorly with nurse assessment (kappa 0.22-0.56). The best predictor was clinical assessment of respiratory distress (LR+ 5.04). Oxygen saturations <94% were highly specific (specificity 95.1%) but had poor sensitivity (35.6%). Tachypnoea (defined by current Advanced Paediatric Life Support standards) offered little discriminatory value.
Parent-reported symptoms were unreliable discriminators of serious respiratory infection in children with suspected acute infection, and did not correlate well with nurse assessment. Using symptoms to identify higher risk children in this setting is unreliable. Nurse triage assessment of respiratory distress and some vital signs are important predictors.
家长报告的症状常用于对儿童进行分诊，但对于哪些症状能识别出患有严重呼吸道感染的儿童，知之甚少。作者旨在确定能识别出严重呼吸道感染的症状和分诊发现，并量化家长和护士评估之间的一致性。
前瞻性诊断队列研究。
考文垂和沃里克郡大学医院 NHS 信托基金儿科评估病房。
535 名年龄在 3 个月至 12 岁之间的疑似急性感染儿童。
家长在到达时完成症状问卷。护士对儿童进行分诊，测量常规生命体征。出院时的最终诊断作为结局。分析症状和分诊发现，以确定对严重呼吸道感染有诊断意义的特征。测量家长和分诊护士评估之间的一致性，并计算κ 值。
家长报告的症状是严重呼吸道感染的不良指标（阳性似然比[LR+]为 0.56-1.93），与护士评估的一致性较差（κ 值为 0.22-0.56）。最佳预测因素是呼吸困难的临床评估（LR+ 5.04）。氧饱和度<94%具有高度特异性（特异性 95.1%），但敏感性较差（35.6%）。按照现行的高级儿科生命支持标准定义的呼吸急促，其鉴别价值较低。
在疑似急性感染的儿童中，家长报告的症状是严重呼吸道感染的不可靠鉴别指标，与护士评估的相关性也较差。在这种情况下，使用症状来识别高危儿童并不可靠。护士对呼吸困难和一些生命体征的分诊评估是重要的预测指标。
