A three-step diagnosis of pediatric pneumonia at the emergency department using clinical predictors, C-reactive protein, and pneumococcal PCR.
A three-step diagnosis of pediatric pneumonia at the emergency department using clinical predictors, C-reactive protein, and pneumococcal PCR.
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DOI：
10.1007/s00431-017-2913-0
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发表时间：
2017-06
影响因子：
3.6
通讯作者：
Galetto-Lacour A
中科院分区：
文献类型：
--
作者：
Alcoba G;Keitel K;Maspoli V;Lacroix L;Manzano S;Gehri M;Tabin R;Gervaix A;Galetto-Lacour A
社区获得性肺炎（CAP）的管理建议主张，在没有细菌性CAP典型的临床和实验室检查结果的情况下，不需要使用抗生素。然而，儿科CAP的临床和实验室预测因子的真正价值仍需评估。这项前瞻性队列研究在三个急诊科招募了142名放射性肺炎儿童。肺炎伴肺实变是主要终点;并发性肺炎（菌血症、脓胸或胸腔积液）是次要终点。我们发现，三种临床体征（单侧肺换气不足、呼噜声和无喘息）、降钙素原（PCT）、C反应蛋白（CRP）升高、鼻咽病毒PCR阴性或血肺炎球菌PCR（P-PCR）阳性与肺炎合并实变和并发肺炎显著相关。阴性临床体征和低CRP值的儿童患肺炎合并实变（13%）或并发肺炎（6%）的概率较低。CRP >80 mg/L和P-PCR阳性联合诊断肺炎的阳性预测值为75%。 结论：结合临床体征和实验室指标的模型可以有效地评估患肺炎的风险。具有阴性临床体征和低CRP的儿童患肺炎的风险较低。对于临床体征阳性且CRP高的患儿，血肺炎球菌PCR阳性可更准确地确诊肺炎。
Recommendations for the management of community-acquired pneumonia (CAP) advocate that, in the absence of the clinical and laboratory findings typical of bacterial CAP, antibiotics are not required. However, the true value of the clinical and laboratory predictors of pediatric CAP still needs to be assessed. This prospective cohort study in three emergency departments enrolled 142 children with radiological pneumonia. Pneumonia with lung consolidation was the primary endpoint; complicated pneumonia (bacteremia, empyema, or pleural effusion) was the secondary endpoint. We showed that three clinical signs (unilateral hypoventilation, grunting, and absence of wheezing), elevated procalcitonin (PCT), C-reactive protein (CRP), negative nasopharyngeal viral PCR, or positive blood pneumococcal PCR (P-PCR) were significantly associated with both pneumonia with consolidation and complicated pneumonia. Children with negative clinical signs and low CRP values had a low probability of having pneumonia with consolidation (13%) or complicated pneumonia (6%). Associating the three clinical signs, CRP >80 mg/L and a positive P-PCR ruled in the diagnosis of complicated pneumonia with a positive predictive value of 75%. Conclusion: A model incorporating clinical signs and laboratory markers can effectively assess the risk of having pneumonia. Children with negative clinical signs and low CRP are at a low risk of having pneumonia. For children with positive clinical signs and high CRP, a positive blood pneumococcal PCR can more accurately confirm the diagnosis of pneumonia.
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DOI：
10.1016/j.jcv.2014.05.006
发表时间：
2014-08
期刊：
Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology
影响因子：
--
作者：
Cantais A;Mory O;Pillet S;Verhoeven PO;Bonneau J;Patural H;Pozzetto B
通讯作者：
Pozzetto B
影响因子：
3.7
作者：
Esposito S;Di Gangi M;Cardinale F;Baraldi E;Corsini I;Da Dalt L;Tovo PA;Correra A;Villani A;Sacco O;Tenero L;Dones P;Gambino M;Zampiero A;Principi N;Ita-CAP Study Group
通讯作者：
Ita-CAP Study Group
影响因子：
3.6
作者：
Cevey-Macherel M;Galetto-Lacour A;Gervaix A;Siegrist CA;Bille J;Bescher-Ninet B;Kaiser L;Krahenbuhl JD;Gehri M
通讯作者：
Gehri M
影响因子：
5
作者：
JOKINEN, C;HEISKANEN, L;MAKELA, PH
通讯作者：
MAKELA, PH
影响因子：
105.7
作者：
Craig, Jonathan C.;Williams, Gabrielle J.;McCaskill, Mary
通讯作者：
McCaskill, Mary