Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
Acad Pediatr. 2019 Jul;19(5):542-548. doi: 10.1016/j.acap.2018.11.015. Epub 2019 Jan 16.
As both fever and pneumonia can be associated with tachypnea, we investigated the relationship between body temperature and respiratory rate (RR) in young children and whether temperature-adjusted RR enhances the prediction of pneumonia.
In this retrospective cross-sectional analysis of 91,429 children < 5 years of age presenting to an urban pediatric emergency department, the relationship between triage RR and temperature was analyzed using regression analysis. We assessed the predictive value of temperature-adjusted RR for the diagnosis of pneumonia; diagnostic performance was evaluated for continuous RR as well as World Health Organization (WHO) age-based RR thresholds.
The mean RR increased 2.6 breaths/minute for each 1°C increase in temperature. Interpatient variability was comparatively large; at any temperature, the interquartile range (75th percentile minus 25th percentile) varied from 4 to 16 breaths/minute. For predicting pneumonia, temperature- and age-adjusted RR was superior to age-adjusted RR: area under the curve (AUC) = 0.76 (95% confidence interval [CI], 0.75-0.78) versus AUC = 0.73 (95% CI, 0.72-0.75), respectively. Using WHO RR criteria, temperature-adjusted RR improved diagnostic discrimination, as the AUC increased from 0.58 (95% CI, 0.57-0.59) to 0.72 (95% CI, 0.70-0.73).
The effects of temperature on respiratory rate are modest, with a mean increase of 2.6 breaths/minute for each 1°C rise in temperature. Despite considerable interpatient variability in respiratory rates by temperature, temperature adjustment improves the diagnostic value of respiratory rate for pneumonia.
发热和肺炎均可导致呼吸急促，本研究旨在探讨小儿体温与呼吸频率（RR）之间的关系，以及体温校正 RR 是否能提高肺炎预测的准确性。
本回顾性横断面分析纳入了 91429 名年龄<5 岁、因急性病就诊于城市儿科急诊的患儿，采用回归分析评估分诊 RR 与体温之间的关系。我们评估了校正 RR 对肺炎诊断的预测价值；连续 RR 和世界卫生组织（WHO）基于年龄的 RR 界值均用于评估诊断性能。
体温每升高 1°C，RR 平均增加 2.6 次/分钟。患者间 RR 差异较大；在任何体温下，RR 的四分位间距（75%分位数与 25%分位数之差）在 4 至 16 次/分钟之间。校正 RR 优于校正年龄后的 RR 预测肺炎的能力：曲线下面积（AUC）分别为 0.76（95%置信区间[CI]，0.75-0.78）和 0.73（95% CI，0.72-0.75）。使用 WHO 的 RR 标准，校正 RR 可提高诊断区分度，AUC 从 0.58（95% CI，0.57-0.59）增加到 0.72（95% CI，0.70-0.73）。
体温对 RR 的影响较小，体温升高 1°C，RR 平均增加 2.6 次/分钟。尽管 RR 随体温变化存在较大的个体间差异，但校正体温可提高 RR 对肺炎的诊断价值。
