Adding fever to WHO criteria for diagnosing pneumonia enhances the ability to identify pneumonia cases among wheezing children
Adding fever to WHO criteria for diagnosing pneumonia enhances the ability to identify pneumonia cases among wheezing children
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DOI：
10.1136/adc.2010.189894
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发表时间：
2011-01-01
影响因子：
5.2
通讯作者：
Cousens, Simon N.
中科院分区：
文献类型：
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作者：
Cardoso, Maria-Regina A.;Nascimento-Carvalho, Cristiana M.;Cousens, Simon N.
目的探讨由世界卫生组织提出的标准的能力，以确定肺炎的情况下出现喘息和增加发热的标准改变其performance.Design前瞻性分类的390名儿童年龄2-59个月的下呼吸道疾病分为五个诊断类别，包括肺炎。WHO标准的肺炎和一组这样的标准，通过添加发烧修改进行了比较，放射学诊断的肺炎为金standard.Results的敏感性WHO标准为94%，年龄= 24个月的儿童。特异性分别为20%和16%。在WHO标准中增加发热显著提高了特异性（分别为44%和50%）。WHO标准对儿童喘息的特异性较差（12%）。增加发烧大大改善了这一点（至42%）。发烧的标准显然降低了他们的敏感性只有轻微的（92%和57%，分别在两个年龄组）。结论作者的结果重申，目前的WHO标准可以检测肺炎的高敏感性，特别是在年幼的儿童。他们提出的证据表明，这些标准区分肺炎儿童和喘息性疾病儿童的能力可能会因增加发热而大大增强。
Objective To examine the ability of the criteria proposed by the WHO to identify pneumonia among cases presenting with wheezing and the extent to which adding fever to the criteria alters their performance.Design Prospective classification of 390 children aged 2-59 months with lower respiratory tract disease into five diagnostic categories, including pneumonia. WHO criteria for the identification of pneumonia and a set of such criteria modified by adding fever were compared with radio-graphically diagnosed pneumonia as the gold standard.Results The sensitivity of the WHO criteria was 94% for children aged = 24 months. The corresponding specificities were 20% and 16%. Adding fever to the WHO criteria improved specificity substantially (to 44% and 50%, respectively). The specificity of the WHO criteria was poor for children with wheezing (12%). Adding fever improved this substantially (to 42%). The addition of fever to the criteria apparently reduced their sensitivity only marginally (to 92% and 57%, respectively, in the two age groups).Conclusion The authors' results reaffirm that the current WHO criteria can detect pneumonia with high sensitivity, particularly among younger children. They present evidence that the ability of these criteria to distinguish between children with pneumonia and those with wheezing diseases might be greatly enhanced by the addition of fever.