Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Queensland, Australia Department of Respiratory Medicine, Royal Children's Hospital, Brisbane, Queensland, Australia.
Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Queensland, Australia Department of Infectious Diseases, Royal Children's Hospital, Brisbane, Queensland, Australia.
Arch Dis Child. 2014 Jun;99(6):522-5. doi: 10.1136/archdischild-2013-304793. Epub 2014 Feb 12.
To determine whether a child with chronic wet cough and poor response to at least 4 weeks of oral antibiotics is more likely to have bronchiectasis.
All chest multi-detector computerised tomography (MDCT) scans at a single paediatric tertiary hospital from April 2010 to August 2012 were reviewed retrospectively so as to identify those ordered by respiratory physicians for assessment of children with a chronic wet cough. Information regarding age, sex, ethnicity, indication for imaging and the response to at least 4 weeks of antibiotics before having the scan were recorded from their charts. The data were analysed using simple and multiple logistic regression.
Of the 144 (87 males) eligible children, 106 (65 males, 30 Indigenous) aged 10-199 months had MDCT scan evidence of bronchiectasis. Antibiotic data were available for 129 children. Among the 105 children with persistent cough despite at least 4 weeks of antibiotics, 88 (83.8%) had bronchiectasis, while of the 24 children whose cough resolved after antibiotics, only six (25.0%) received this diagnosis (adjusted OR 20.9; 95% CI 5.36 to 81.8). Being Indigenous was also independently associated with radiographic evidence of bronchiectasis (adjusted OR 5.86; 95% CI 1.20 to 28.5).
Further investigations including a MDCT scan should be considered in a child with a chronic wet cough that persists following 4 weeks of oral antibiotics. However, while reducing the likelihood of underlying bronchiectasis, responding well to a single prolonged course of antibiotics does not exclude this diagnosis completely.
确定慢性湿性咳嗽且至少对 4 周口服抗生素反应不佳的儿童是否更有可能患有支气管扩张症。
回顾性分析 2010 年 4 月至 2012 年 8 月期间在一家儿科三级医院进行的所有胸部多排计算机断层扫描（MDCT），以确定呼吸科医生为评估慢性湿性咳嗽儿童而进行的 MDCT 扫描。从病历中记录了年龄、性别、种族、成像指征以及在进行扫描前至少 4 周使用抗生素的反应等信息。使用简单和多元逻辑回归分析数据。
在 144 名（87 名男性）符合条件的儿童中，有 106 名（65 名男性，30 名原住民）年龄为 10-199 个月，MDCT 扫描显示有支气管扩张症证据。有 129 名儿童的抗生素数据可用。在 105 名持续咳嗽但至少使用 4 周抗生素的儿童中，有 88 名（83.8%）有支气管扩张症，而在 24 名抗生素治疗后咳嗽缓解的儿童中，只有 6 名（25.0%）诊断为支气管扩张症（调整后的比值比 20.9；95%CI 5.36 至 81.8）。原住民也是与放射学支气管扩张症证据独立相关的因素（调整后的比值比 5.86；95%CI 1.20 至 28.5）。
在儿童慢性湿性咳嗽持续 4 周口服抗生素后，应考虑进一步进行包括 MDCT 扫描在内的检查。然而，尽管单一延长疗程抗生素治疗反应良好可降低潜在支气管扩张症的可能性，但并不能完全排除该诊断。
