Roberts J, Barnes W, Pennock M, Browne G
Department of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Heart Lung. 1988 Mar;17(2):166-70.
Various prevalence rates have been estimated for pulmonary complications after abdominal surgery, and fever has been thought to be a diagnostic indicator. This study quantifies the diagnostic accuracy of fever as a measure of postoperative pulmonary complications and includes the sensitivity, specificity, and positive and negative predictive values. Assessments using fever and chest x-ray film were determined for 270 patients after elective intra-abdominal surgery in three hospitals with six practicing surgeons in a Southern Ontario city. With use of reliable chest x-ray reports indicating lung pathologic findings as positive for pulmonary complication, the prevalence of a positive finding was 57%. The prevalence of a fever (temperature greater than or equal to 38 degrees C) was 40%. The sensitivity and negative predictive value of fever were slightly below 50%, and the specificity and positive predictive value of fever was 68% and 66% respectively. Fever was an accurate indicator of x-ray evidence of atelectasis in only 56% of the subjects. Therefore, neither the presence nor the absence of fever can assure clinicians of the presence or absence of a postoperative pathologic pulmonary complication such as atelectasis.
腹部手术后肺部并发症的患病率已有多种估计，发热一直被视为诊断指标。本研究量化了发热作为术后肺部并发症衡量指标的诊断准确性，包括敏感性、特异性以及阳性和阴性预测值。在安大略省南部一个城市的三家医院，由六位外科医生对270例择期腹部手术后的患者进行了发热和胸部X光片评估。根据可靠的胸部X光报告显示肺部病理结果为肺部并发症阳性，阳性结果的患病率为57%。发热（体温大于或等于38摄氏度）的患病率为40%。发热的敏感性和阴性预测值略低于50%，特异性和阳性预测值分别为68%和66%。发热仅在56%的受试者中是肺不张X光证据的准确指标。因此，发热的存在与否都不能让临床医生确定是否存在术后病理性肺部并发症，如肺不张。
