儿科急诊室中的急性阻塞性呼吸道疾病：循证评估

Kilic Ayse, Ünüvar Emin, Sütçü Murat, Süleyman Ayşe, Tamay Zeynep, Yildiz Ismail, Oguz Fatma, Sidal Müjgan, Güler Nermin

Division of Ambulatory Pediatrics, University of Istanbul, Istanbul, Turkey.

Pediatr Emerg Care. 2012 Dec;28(12):1321-7. doi: 10.1097/PEC.0b013e3182768d17.

OBJECTIVES

The objective of this study was to determine the evidence-based performance of the pediatric emergency unit in the diagnosis of and treatment approach to the patients with asthma, bronchiolitis, and croup.

METHODS

In this study conducted in a retrospective cross-sectional way, emergency cards and computer data have been used. In the performance evaluation, the National Hospital Ambulatory Medical Care Survey criteria were considered. In the evaluation of performance in diagnosis, the rates of chest x-ray studies and use of corticosteroids and antibiotics were examined. Use of antibiotics in the cases not having a fever or any symptoms of bacterial infection and failure in prescribing steroids to the cases with moderate-to-severe symptoms were considered as bad performance criteria. χ(2) test was used for the data, which can be classified; Mann-Whitney U and Student t tests were used for the data with normal distribution and for the continuous variables.

RESULTS

Study groups were composed of 2795 patients (1742 cases with asthma, 115 cases with croup, 938 cases with bronchiolitis) aged between 3 and 140 months (mean [SD], 41.2 [31] months). Chest x-ray study was requested significantly more often in the cases of bronchiolitis and croup with severe symptoms. In asthma cases, chest x-ray study was requested in those with severe clinical symptoms. In all 3 groups, a significant difference between the severity levels of the cases, from whom hemogram was requested, was determined. Biochemical tests were requested more often in those with severe bronchiolitis or asthma. Antibiotics were prescribed to none of the mild bronchiolitis cases. However, steroids were recommended more often to patients with moderate and severe bronchiolitis. They were administered to all patients with croup. Systemic steroids were prescribed more often to those with moderate or severe asthma.

CONCLUSIONS

In our unit, both antibiotics administration and chest x-ray studies requested in patients with bronchiolitis, croup, and asthma were in low rates. Steroids in asthma attacks were found to be high in severe cases and in croup cases as well.

目的

本研究的目的是确定儿科急诊科对哮喘、细支气管炎和喉炎患者的诊断及治疗方法的循证表现。

方法

本研究采用回顾性横断面研究方法，使用了急诊病历卡和计算机数据。在绩效评估中，考虑了国家医院门诊医疗调查标准。在诊断绩效评估中，检查了胸部X光检查的比例以及皮质类固醇和抗生素的使用情况。在无发热或任何细菌感染症状的病例中使用抗生素，以及在中重度症状病例中未开具类固醇药物被视为不良绩效标准。对于可分类的数据使用χ(2)检验，对于正态分布的数据和连续变量使用曼-惠特尼U检验和学生t检验。

结果

研究组由2795例患者组成（1742例哮喘患者、115例喉炎患者、938例细支气管炎患者），年龄在3至140个月之间（平均[标准差]，41.2[31]个月）。在症状严重的细支气管炎和喉炎病例中，要求进行胸部X光检查的频率明显更高。在哮喘病例中，有严重临床症状的患者要求进行胸部X光检查。在所有3组中，确定了要求进行血常规检查的病例严重程度水平之间存在显著差异。在严重细支气管炎或哮喘患者中，要求进行生化检查的频率更高。轻度细支气管炎病例均未使用抗生素。然而，中重度细支气管炎患者更常被推荐使用类固醇。所有喉炎患者均使用了类固醇。中重度哮喘患者更常开具全身性类固醇。