Kolstad P R, Burnham G, Kalter H D, Kenya-Mugisha N, Black R E
Department of International Health, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205, USA.
Bull World Health Organ. 1997;75 Suppl 1(Suppl 1):77-85.
Bringing together various disease-specific guidelines for sick children, WHO and UNICEF have developed an Integrated Management of Childhood Illness (IMCI) algorithm, one component of which (assess and classify) was tested in the outpatient department of a rural district hospital in western Uganda. Children aged 2-59 months were seen first by a Ugandan medical assistant trained in IMCI, and then evaluated by a medical officer. Sensitivity, specificity and positive predictive values were determined by comparing the IMCI classifications with a reference standard based on the medical officers' diagnoses and laboratory tests. Of the 1226 children seen, 69% were classified into more than one symptom category, 7% were not classified in any symptom category, 8% had a danger sign, and 16% were classified into a severe category, for which the IMCI approach recommended urgent hospital referral. Specificity for most classifications was good, though sensitivity and positive predictive values were variable. We conclude that the IMCI algorithm is an important advance in the primary care of sick children in developing countries.
世界卫生组织和联合国儿童基金会汇集了针对患病儿童的各种特定疾病指南，制定了儿童疾病综合管理（IMCI）算法，其中一个组成部分（评估和分类）在乌干达西部一家农村地区医院的门诊部进行了测试。2至59个月大的儿童首先由一名接受过IMCI培训的乌干达医疗助理进行检查，然后由一名医务人员进行评估。通过将IMCI分类与基于医务人员诊断和实验室检查的参考标准进行比较，确定了敏感性、特异性和阳性预测值。在接受检查的1226名儿童中，69%被归类为不止一个症状类别，7%未被归类到任何症状类别，8%有危险体征，16%被归类为严重类别，针对严重类别IMCI方法建议紧急转诊至医院。大多数分类的特异性良好，不过敏感性和阳性预测值各不相同。我们得出结论，IMCI算法是发展中国家患病儿童初级保健方面的一项重要进展。
