Clinical signs that predict severe illness in children underage 2 months: a multicentre study
Clinical signs that predict severe illness in children underage 2 months: a multicentre study
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DOI：
10.1016/s0140-6736(08)60106-3
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发表时间：
2008-01-12
期刊：
影响因子：
168.9
通讯作者：
Bahl, Rajiv
中科院分区：
文献类型：
--
作者：
Carlin, John B.;Darmstadt, Gary L.;Bahl, Rajiv
背景新生儿疾病，特别是在生命的第一周，是世界范围内死亡的主要原因。改善对需要转诊的幼龄婴儿的识别对公共卫生具有重要意义。方法在孟加拉国、玻利维亚、加纳、印度和南非的卫生机构招募了2个月以下的患病婴儿，分为两个年龄组：0-6天和7-59天。一名训练有素的卫生工作者记录了巴基斯坦的31种症状和临床体征。一名儿科专家独立评估了每个病例是否患有需要住院治疗的严重疾病。我们分别检查了每种症状和体征的敏感性、特异性和比值比（OR），并将其合并到算法中，以评估它们在预测严重疾病（不包括黄疸）方面的价值。结果3177名0-6日龄儿童和5712名7-59日龄婴儿入组。12个症状或体征预示着生命第一周的严重疾病：进食困难史（or 10）。0, 95% ci, 6。9-14。5)、惊厥史（15.4,6.4-37）。2)嗜睡(3.5,1.7-7。1)，只有在刺激时才运动（6.9,3.0-15.5），呼吸频率每分钟60次或更多（2- 7,1.9 -3.8），咕噜声（2.9,1.1-7.5），严重胸内缩（8.9,4）。0-20。1)，温度为37.5℃或以上（3.4,2.4-4.9）或低于35.5℃（9.2,4）。6-18.6)，毛细血管再充盈时间延长(10。5,5.1 -21.7)，发绀（13.7,1.6-116.5）和四肢僵硬（15.1,2.2-105.9）。要求存在任何一种体征的决策规则具有高灵敏度（87%）和特异性（74%）。我们将算法简化为7个体征（进食困难史、抽搐史、仅受刺激时才运动、呼吸频率每分钟60次及以上、严重胸内缩、体温37.5℃及以上或以下35.5℃）后，主要基于每个体征或症状的患病率，敏感性（85%）和特异性（75%）大致相同。这7个征象在7-59天的婴儿中也表现良好（敏感性74%，特异性79%）。可推荐一种单一的简单算法，用于识别被送往卫生机构的0-2个月婴儿的严重疾病。需要进一步研究在常规家访期间对社区新生儿进行疾病筛查。
Background Neonatal illness, particularly in the first week of life, is a leading cause of death worldwide. Improving identification of young infants who require referral for severe illness is of major public-health importance.Methods infants under 2 months of age brought with illness to health facilities in Bangladesh, Bolivia, Ghana, India, and South Africa were recruited in two age-groups: 0-6 days and 7-59 days. A trained health worker recorded Pakistan 31 symptoms and clinical signs. An expert paediatrician assessed each case independently for severe illness that required hospital admission. We examined the sensitivity, specificity, and odds ratio (OR) for each symptom and sign individually and combined into algorithms to assess their value for predicting severe illness, excluding jaundice.Findings 3177 children aged 0-6 days and 5712 infants aged 7-59 days were enrolled. 12 symptoms or signs predicted severe illness in the first week of life: history of difficulty feeding (OR 10 . 0, 95% CI, 6. 9-14 . 5), history of convulsions (15.4, 6.4-37 . 2), lethargy (3.5, 1.7-7. 1), movement only when stimulated (6.9, 3.0-15.5), respiratory rate of 60 breaths per minute or more (2-7, 1.9-3.8), grunting (2.9, 1.1-7.5), severe chest indrawing (8.9, 4. 0-20. 1), temperature of 37.5 degrees C or more (3.4, 2.4-4.9) or below 35.5 degrees C (9.2, 4. 6-18.6), prolonged capillary refill (10 . 5, 5.1-21.7), cyanosis (13.7, 1.6-116.5), and stiff limbs (15.1, 2.2-105.9). A decision rule requiring the presence of any one sign had high sensitivity (87%) and specificity (74%). After we reduced the algorithm to seven signs (history of difficulty feeding, history of convulsions, movement only when stimulated, respiratory rate of 60 breaths per minute or more, severe chest indrawing, temperature of 37.5 degrees C or more or below 35.5 degrees C), mainly on the basis of prevalence of each sign or symptom, sensitivity (85%) and specificity (75%) were much the same. These seven signs also did well in 7-59-day-old infants (sensitivity 74%, specificity 79%).Interpretation A single simple algorithm could be recommended for identifying severe illness in infants aged 0-2 months who are brought to health facilities. Further research is needed on screening newborn children for illness in the community during routine home visits.