Does this infant have pneumonia?
Does this infant have pneumonia?
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DOI：
10.1001/jama.279.4.308
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发表时间：
1998-01-28
影响因子：
120.7
通讯作者：
Gadomski, A
中科院分区：
文献类型：
--
作者：
Margolis, P;Gadomski, A
急性下呼吸道疾病在接受初级保健的儿童中很常见。我们回顾了临床检查在检测儿童肺炎中的准确性和精密度。虽然大多数病例是病毒性的，但重要的是要识别细菌性肺炎，以提供适当的治疗。通过检索1982年至1995年的MEDLINE、查阅参考文献列表、查阅已发表的临床检查研究概要和咨询专家来确定研究。观察者一致性对于临床检查中的大多数体征是好的。每项研究均由2名观察员进行审查，并对方法学质量进行评分。对于可以观察到的腿部体征、使用辅助肌肉、颜色、注意力; kappa，0.48-0.66），比需要听诊的胸部腿部体征、偶发音; kappa，0.3）更一致。通过计数60秒来增强呼吸率的测量。排除肺炎的最佳个体检查结果是没有呼吸急促。胸部内吸和其他呼吸功增加的迹象增加了肺炎的可能性。如果所有临床体征（呼吸频率、听诊和呼吸功）均为阴性，则胸部X线检查结果不太可能为阳性。需要进行研究，以评估临床结果在一起使用时的价值。
Acute lower respiratory tract illness is common among children seen in primary care. We reviewed the accuracy and precision of the clinical examination in detecting pneumonia in children. Although most cases are viral, it is important to identify bacterial pneumonia to provide appropriate therapy. Studies were identified by searching MEDLINE from 1982 to 1995, reviewing reference lists, reviewing a published compendium of studies of the clinical examination, and consulting experts. Observer agreement is good for most signs on the clinical examination. Each study was reviewed by 2 observers and graded for methodologic quality. There is better agreement about signs that can be observed leg, use of accessory muscles, color, attentiveness; kappa, 0.48-0.66) than signs that require auscultation of the chest leg, adventitious sounds; kappa, 0.3). Measurements of the respiratory rate are enhanced by counting for 60 seconds. The best individual finding for ruling out pneumonia is the absence of tachypnea. Chest indrawing, and other signs of increased work of breathing, increases the likelihood of pneumonia. If all clinical signs (respiratory rate, auscultation, and work of breathing) are negative, the chest x-ray findings are unlikely to be positive. Studies are needed to assess the value of clinical findings when they are used together.