Heckerling P S, Tape T G, Wigton R S, Hissong K K, Leikin J B, Ornato J P, Cameron J L, Racht E M
Department of Medicine, University of Illinois, Chicago 60680.
Ann Intern Med. 1990 Nov 1;113(9):664-70. doi: 10.7326/0003-4819-113-9-664.
To derive and validate a clinical rule for predicting pneumonic infiltrates in adult patients with acute respiratory illness.
Prevalence studies in three settings.
Emergency departments of the University of Illinois Hospital at Chicago, the University of Nebraska Medical Center at Omaha, and the Medical College of Virginia at Richmond.
Symptoms, signs, comorbidity data, and chest roentgenogram results were recorded for 1134 patients from Illinois (the derivation set), 150 patients from Nebraska, and 152 patients from Virginia (the validation sets). All patients presented to the emergency department and had a chest roentgenogram to evaluate fever or respiratory complaints.
Within the training set, temperature greater than 37.8 degrees C, pulse greater than 100 beats/min, rales, decreased breath sounds, and the absence of asthma were identified as significant predictors of radiographically proved pneumonia in a stepwise logistic regression model (P = 0.001). The logistic rule discriminated patients with and without pneumonia in the training set with a receiver operating characteristic (ROC) area of 0.82. In the validation sets, the rule discriminated pneumonia and nonpneumonia with ROC areas of 0.82 and 0.76 after adjusting for differences in disease prevalence (P greater than 0.2 compared with the training set). The predicted probability of having pneumonia for patients with different clinical findings corresponded closely with the incidence of pneumonia among patients with such findings in the three settings.
Among adults presenting with acute respiratory illness, a prediction rule based on clinical findings accurately discriminated patients with and without radiographic pneumonia, and was used in two other samples of patients without significant decrement in discriminatory ability. This rule can be used by physicians to develop more effective strategies for detecting pneumonia and for helping to determine the need for radiologic study among patients with acute respiratory disease.
推导并验证一项用于预测成年急性呼吸道疾病患者肺部浸润的临床规则。
在三种环境下进行患病率研究。
芝加哥伊利诺伊大学医院急诊科、奥马哈内布拉斯加大学医学中心以及里士满弗吉尼亚医学院。
记录了来自伊利诺伊州的1134例患者（推导组）、来自内布拉斯加州的150例患者以及来自弗吉尼亚州的152例患者（验证组）的症状、体征、合并症数据及胸部X线检查结果。所有患者均到急诊科就诊，并进行胸部X线检查以评估发热或呼吸道症状。
在训练组中，逐步逻辑回归模型显示体温高于37.8摄氏度、脉搏大于100次/分钟、啰音、呼吸音减弱以及无哮喘是影像学确诊肺炎的显著预测因素（P = 0.001）。该逻辑规则在训练组中区分有无肺炎患者的受试者工作特征（ROC）曲线下面积为0.82。在验证组中，调整疾病患病率差异后，该规则区分肺炎和非肺炎的ROC曲线下面积分别为0.82和0.76（与训练组相比，P大于0.2）。不同临床表现患者患肺炎的预测概率与三种环境下有此类表现患者的肺炎发病率密切对应。
在患有急性呼吸道疾病的成年人中，基于临床表现的预测规则能准确区分有无影像学肺炎的患者，并且在另外两组患者样本中使用时鉴别能力无显著下降。该规则可供医生用于制定更有效的策略来检测肺炎，并帮助确定急性呼吸道疾病患者是否需要进行影像学检查。
