体格检查在肺炎诊断确立中的作用。
The role of physical examination in establishing the diagnosis of pneumonia.
作者信息
Ayalon Itay, Glatstein Miguel Marcelo, Zaidenberg-Israeli Galit, Scolnik Dennis, Ben Tov Amir, Ben Sira Liat, Reif Shimon
机构信息
Division of Pediatric Department, Dana-Dwek Children's Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
出版信息
Pediatr Emerg Care. 2013 Aug;29(8):893-6. doi: 10.1097/PEC.0b013e31829e7d6a.
BACKGROUND
Community-acquired pneumonia (CAP) is an important cause of acute respiratory disease in ambulatory care settings. The objective of this study was to assess the accuracy of medical history and physical examination in diagnosing CAP.
METHODS
Pediatric residents prospectively completed a questionnaire documenting patients' medical history and physical examination whenever a chest radiograph was ordered on patients 1 month to 16 years of age. Chest radiographs were read by a pediatric radiologist.
RESULTS
Of 525 children participating in the study, 181 (34%) demonstrated findings of pneumonia. Thirty-four (19%) had no symptoms other than fever, and 51 (28%) had normal lung auscultation. Pediatric residents had the same interpretation in 85% of cases in which radiographic CAP was diagnosed by the radiologist, and in 76% of cases in which radiographic pneumonia was excluded by the radiologist.
CONCLUSIONS
Results demonstrate the significant added value of chest radiography as an ancillary test for diagnosis of pneumonia in the emergency department setting.
背景
社区获得性肺炎（CAP）是门诊医疗环境中急性呼吸道疾病的重要病因。本研究的目的是评估病史和体格检查在诊断CAP中的准确性。
方法
儿科住院医师在为1个月至16岁的患者开具胸部X线检查单时，前瞻性地完成一份记录患者病史和体格检查的问卷。胸部X线片由儿科放射科医生阅片。
结果
参与研究的525名儿童中，181名（34%）显示有肺炎表现。34名（19%）除发热外无其他症状，51名（28%）肺部听诊正常。在放射科医生诊断为影像学CAP的病例中，85%的病例儿科住院医师的解读与之相同；在放射科医生排除影像学肺炎的病例中，76%的病例儿科住院医师的解读与之相同。
结论
结果表明，在急诊科环境中，胸部X线检查作为诊断肺炎的辅助检查具有显著的附加价值。
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