英国胸科学会儿童社区获得性肺炎严重程度标准的验证。
Validation of the British Thoracic Society Severity Criteria for Pediatric Community-acquired Pneumonia.
机构信息
From the Sections of Emergency Medicine and Hospital Medicine, Children's Hospital Colorado, Denver, Colorado.
Department of Pediatrics, University of Colorado School of Medicine.
出版信息
Pediatr Infect Dis J. 2019 Sep;38(9):894-899. doi: 10.1097/INF.0000000000002380.
BACKGROUND
The British Thoracic Society (BTS) guideline for pediatric community-acquired pneumonia (CAP) outlines severity criteria to guide clinical decision-making. Our objective was to examine the predictive performance of the criteria on the need for hospitalization (NFH) and disposition.
METHODS
This was a retrospective cohort study of children 3 months-18 years of age diagnosed with CAP in an urban, pediatric emergency department (ED) in the United States from September 2014 to August 2015. Children with chronic medical conditions, recent ED visits, and ED transfers were excluded. The main outcomes were interventions or diagnoses that necessitate hospitalization (ie, NFH) and disposition (eg, admit vs. discharge). Test characteristics, stratified by age, were calculated for each outcome.
RESULTS
Of 518 eligible children, 56.6% (n = 293) were discharged from the ED with 372 children meeting at least 1 BTS criterion. Overall BTS criteria were specific but not sensitive for NFH nor for disposition. For children <1 year of age sensitive criteria included not feeding and temperature for NFH and tachycardia, cyanosis and not feeding for disposition. For children ≥1 year of age, tachycardia had a sensitivity of >0.60 for both outcomes. The areas under the receiver operator characteristic curves for predicting any BTS criteria was 0.57 for NFH and 0.84 for disposition.
CONCLUSIONS
The BTS CAP severity criteria had fair to excellent ability to predict NFH and disposition, respectively. Although specific, the low sensitivity and poor discriminatory ability for NFH of these criteria suggest a need for improved prognostic tools for children with CAP.
背景
英国胸科学会（BTS）的儿童社区获得性肺炎（CAP）指南概述了指导临床决策的严重程度标准。我们的目的是检验这些标准对住院需求（NFH）和处置的预测性能。
方法
这是一项在美国城市儿科急诊室（ED）对 2014 年 9 月至 2015 年 8 月期间诊断为 CAP 的 3 个月至 18 岁儿童进行的回顾性队列研究。排除患有慢性疾病、近期 ED 就诊和 ED 转院的儿童。主要结局是需要住院治疗（即 NFH）和处置（如入院与出院）的干预或诊断。根据年龄对每种结局计算了测试特征。
结果
在 518 名符合条件的儿童中，56.6%（n = 293）从 ED 出院，372 名儿童符合至少 1 项 BTS 标准。总体而言，BTS 标准对于 NFH 和处置的特异性较高，但敏感性较低。对于<1 岁的儿童，NFH 的敏感标准包括不进食和体温，而对于处置则包括心动过速、发绀和不进食。对于≥1 岁的儿童，心动过速对于这两种结局的敏感性均>0.60。预测任何 BTS 标准的受试者工作特征曲线下面积对于 NFH 为 0.57，对于处置为 0.84。
结论
BTS CAP 严重程度标准分别具有良好到优秀的预测 NFH 和处置的能力。尽管特异性较高，但这些标准对于 NFH 的敏感性和区分能力较低，表明需要为 CAP 患儿开发更好的预后工具。
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