A systematic review on the diagnosis of pediatric bacterial pneumonia: when gold is bronze.
A systematic review on the diagnosis of pediatric bacterial pneumonia: when gold is bronze.
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DOI：
10.1371/journal.pone.0011989
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发表时间：
2010-08-06
期刊：
影响因子：
3.7
通讯作者：
Johnson DW
中科院分区：
文献类型：
--
作者：
Lynch T;Bialy L;Kellner JD;Osmond MH;Klassen TP;Durec T;Leicht R;Johnson DW
在发展中国家，肺炎是五岁以下儿童死亡的主要原因之一，因此及时准确的诊断至关重要。在北美，肺炎也是儿童发病率和偶尔死亡率的常见来源。临床医生传统上使用胸片作为诊断肺炎的金标准，但他们越来越意识到它并不理想。许多研究表明，胸部X线检查结果缺乏精确的定义儿童肺炎的病因。没有一种单一的测试可以可靠地区分细菌和非细菌原因。这些因素导致临床医生在历史上使用体征和胸片的组合作为“金标准”，尽管这种测试组合已被证明对于诊断和分配治疗是不完美的。本系统评价的目的是：1）识别和分类使用单一或多种检测作为评估其他检测准确性的金标准的研究，2）根据所使用的“金标准”，确定这些其他检测诊断儿童细菌性肺炎的准确性。检索策略的制定，使用的主题词和关键词相结合，从成立到2008年5月，18个电子书目数据库。纳入已发表的研究，如果它们：1）包括1个月至18岁的儿童，2）提供关于诊断准确性的足够数据以构建2×2表格，3）评估一个或多个索引测试的准确性与其他测试相比用作“金标准”。文献检索显示了5，989篇参考文献，其中256篇被筛选纳入，导致25项研究符合所有纳入标准。这些研究检查了一系列细菌类型，并评估了几种诊断测试组合的准确性。在纳入的25项研究中研究了11种不同的金标准。使用11个不同的金标准计算14个不同指标测试的标准有效性。最常用的金标准是6项研究中使用的血培养试验。14个不同的测试作为指标测试进行测量。PCT是五项研究中最常见的测量方法，每项研究都采用不同的金标准。我们发现，评估儿童细菌性肺炎临床、放射学和实验室检查诊断准确性的研究使用了一组异质性的金标准，并发现，至少部分是因为这一点，指数测试的准确性差异很大。这些发现强调了需要确定一个广泛接受的诊断儿童细菌性肺炎的金标准。
In developing countries, pneumonia is one of the leading causes of death in children under five years of age and hence timely and accurate diagnosis is critical. In North America, pneumonia is also a common source of childhood morbidity and occasionally mortality. Clinicians traditionally have used the chest radiograph as the gold standard in the diagnosis of pneumonia, but they are becoming increasingly aware that it is not ideal. Numerous studies have shown that chest radiography findings lack precision in defining the etiology of childhood pneumonia. There is no single test that reliably distinguishes bacterial from non-bacterial causes. These factors have resulted in clinicians historically using a combination of physical signs and chest radiographs as a ‘gold standard’, though this combination of tests has been shown to be imperfect for diagnosis and assigning treatment. The objectives of this systematic review are to: 1) identify and categorize studies that have used single or multiple tests as a gold standard for assessing accuracy of other tests, and 2) given the ‘gold standard’ used, determine the accuracy of these other tests for diagnosing childhood bacterial pneumonia. Search strategies were developed using a combination of subject headings and keywords adapted for 18 electronic bibliographic databases from inception to May 2008. Published studies were included if they: 1) included children one month to 18 years of age, 2) provided sufficient data regarding diagnostic accuracy to construct a 2×2 table, and 3) assessed the accuracy of one or more index tests as compared with other test(s) used as a ‘gold standard’. The literature search revealed 5,989 references of which 256 were screened for inclusion, resulting in 25 studies that satisfied all inclusion criteria. The studies examined a range of bacterium types and assessed the accuracy of several combinations of diagnostic tests. Eleven different gold standards were studied in the 25 included studies. Criterion validity was calculated for fourteen different index tests using eleven different gold standards. The most common gold standard utilized was blood culture tests used in six studies. Fourteen different tests were measured as index tests. PCT was the most common measured in five studies each with a different gold standard. We have found that studies assessing the diagnostic accuracy of clinical, radiological, and laboratory tests for bacterial childhood pneumonia have used a heterogeneous group of gold standards, and found, at least in part because of this, that index tests have widely different accuracies. These findings highlight the need for identifying a widely accepted gold standard for diagnosis of bacterial pneumonia in children.