Silver R B, Ginsburg C M
Clin Pediatr (Phila). 1984 Feb;23(2):81-4. doi: 10.1177/000992288402300203.
We studied 133 asthmatic children in the emergency room who were aged 4 to 17 years and who were not receiving ongoing training in pulmonary function testing, to determine whether spirometry correlated with the outcome of the emergency treatment of the acute attack and with relapse during the next four days. A clinical score derived from the physical exam was obtained at the time of spirometry. Patients were hospitalized or discharged home based solely on their clinical response to therapy. The pediatrician making that decision was blinded to the results of the spirometry. The initial pretreatment clinical score or spirometry alone identified the majority of patients hospitalized, but each falsely identified many discharged patients who did not relapse, 20 percent and 15 percent, respectively. Predictive criteria for hospitalization, combining spirometry with a careful clinical evaluation prior to the start of emergency treatment, substantially reduced the number of falsely identified patients. With use of the predictive criteria, the majority of children admitted to the hospital would have been identified hours before that decision was made on clinical grounds alone (5.5 +/- 0.7 hrs). This study suggests a role for spirometry as an adjunct to clinical evaluation in the early identification of the need for hospitalization of acutely ill asthmatic children.
我们对133名年龄在4至17岁之间、未接受过肺功能测试持续培训的急诊室哮喘儿童进行了研究，以确定肺活量测定法是否与急性发作的急诊治疗结果以及接下来四天内的复发情况相关。在进行肺活量测定时，从体格检查中得出一个临床评分。患者仅根据其对治疗的临床反应而被收治住院或出院回家。做出该决定的儿科医生对肺活量测定结果不知情。单独的初始治疗前临床评分或肺活量测定法可识别出大多数住院患者，但各自都错误地识别出许多未复发的出院患者，分别为20%和15%。将肺活量测定法与急诊治疗开始前的仔细临床评估相结合的住院预测标准，大幅减少了错误识别患者的数量。使用该预测标准，大多数入院儿童在仅基于临床理由做出该决定数小时前（5.5 +/- 0.7小时）就会被识别出来。这项研究表明，肺活量测定法在早期识别急性病哮喘儿童住院需求方面可作为临床评估的辅助手段发挥作用。
