Hewson P H, Gollan R A
Department of Paediatrics, University of Melbourne, Geelong Hospital, Victoria, Australia.
J Paediatr Child Health. 1995 Feb;31(1):29-32. doi: 10.1111/j.1440-1754.1995.tb02908.x.
To determine the simplest combination of symptoms and signs for use as a triaging procedure in young infants presenting to hospital, and to compare this with the 'Baby Check' system.
Six hundred and eighty-two babies were assessed when presenting with acute illness to a children's hospital emergency department. Results of analysis were compared to the results of the Baby Check system, which was derived from the data on the same babies.
The presence of at least one of the following markers: drowsiness on examination, significant chest wall recession, generalized pallor, a history of feeding less than 50% or decreased activity, had a sensitivity of 91%, a specificity of 72%, a positive predictive value of 29% and a negative predictive value of 98% when predicting the need for intervention in hospital. The 'Baby Check' system with a score of 13 or more had a sensitivity of 95%, a specificity of 70%, a positive predictive value of 28% and a negative predictive value of 99%. Less common but predictive markers such as bile-stained vomiting, respiratory grunt, apnoea and convulsions add further to the sensitivity. Based on this data set, if historical variables alone (the presence of either drowsiness, difficult breathing, being more pale than usual, feeding less than 50% or decreased activity) were used (as in telephone screening) 92% of babies needing treatment in hospital would be identified.
A simple five-marker system is almost as powerful as the 19-marker Baby Check system and provides a useful basis for a triaging system and educational guidelines when assessing sick babies.
确定用于对入院的幼儿进行分诊的症状和体征的最简单组合，并将其与“婴儿检查”系统进行比较。
682名患有急性疾病的婴儿在儿童医院急诊科就诊时接受了评估。将分析结果与“婴儿检查”系统的结果进行比较，该系统的数据来自同一批婴儿。
在预测住院干预需求时，存在以下至少一种指标：检查时嗜睡、明显的胸壁凹陷、全身苍白、进食少于50%或活动减少的病史，其敏感性为91%，特异性为72%，阳性预测值为29%，阴性预测值为98%。得分13分及以上的“婴儿检查”系统，其敏感性为95%，特异性为70%，阳性预测值为28%，阴性预测值为99%。胆汁样呕吐、呼吸呻吟、呼吸暂停和惊厥等不太常见但具有预测性的指标进一步提高了敏感性。基于该数据集，如果仅使用病史变量（嗜睡、呼吸困难、比平时更苍白、进食少于50%或活动减少）（如电话筛查），92%需要住院治疗的婴儿将被识别出来。
一个简单的五项指标系统几乎与包含19项指标的“婴儿检查”系统一样有效，为评估患病婴儿时的分诊系统和教育指南提供了有用的基础。
