Diagnostic performance of visible severe wasting for identifying severe acute malnutrition in children admitted to hospital in Kenya.
Diagnostic performance of visible severe wasting for identifying severe acute malnutrition in children admitted to hospital in Kenya.
复制标题
肯尼亚入院儿童严重急性营养不良的明显严重消瘦的诊断性能。
DOI：
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发表时间：
2011
影响因子：
11.1
通讯作者：
J. Berkley
中科院分区：
文献类型：
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作者：
Polycarp Mogeni;Hemed Twahir;V. Bandika;Laura Mwalekwa;J. Thitiri;M. Ngari;Christopher Toromo;K. Maitland;J. Berkley
目的
在肯尼亚的两家公立医院，确定可见的严重消瘦在识别严重急性营养不良中的诊断价值。
方法
这是一项横断面研究，研究对象为一家农村医院和一家城市医院收治的6至59.9个月的儿童。入院时，测量上臂中围（MUAC）、体重和身高，并评估是否存在可见的严重消瘦。根据人体测量标准评价可见严重消瘦的诊断性能。
结果
在11，166名住院儿童中，563名（5%）患有恶性营养不良症，1406名（12.5%）严重消瘦（MUAC <11.5 cm）。根据MUAC <11.5 cm评估，两家医院可见严重消瘦的联合敏感性和特异性为54%，（95%置信区间，CI：51 - 56）和96%（95%CI：96 - 97）;在一家医院，其对身高体重z评分低于-3的敏感性和特异性为44.7%（95% CI：42 - 48）和96.5%（95% CI：96 - 97）。被正确识别为明显严重消瘦的严重消瘦儿童通常年龄较大，消瘦程度更严重，更经常患有恶性营养不良症，更经常对人类免疫缺陷病毒呈阳性，患病时间更长，死亡风险更大。可见的严重消瘦对确定死亡风险的敏感性低于人体测量。没有证据支持测量MUAC和身高别体重z评分。
结论
可见的严重消瘦未能发现约一半的儿童入院严重急性营养不良诊断人体测量。MUAC的常规筛查快速、简单、便宜，应成为研究中所有儿科住院患者标准评估的一部分。
OBJECTIVE
To determine the diagnostic value of visible severe wasting in identifying severe acute malnutrition at two public hospitals in Kenya.
METHODS
This was a cross-sectional study of children aged 6 to 59.9 months admitted to one rural and one urban hospital. On admission, mid-upper arm circumference (MUAC), weight and height were measured and the presence of visible severe wasting was assessed. The diagnostic performance of visible severe wasting was evaluated against anthropometric criteria.
FINDINGS
Of 11,166 children admitted, 563 (5%) had kwashiorkor and 1406 (12.5%) were severely wasted (MUAC < 11.5 cm). The combined sensitivity and specificity of visible severe wasting at the two hospitals, as assessed against a MUAC < 11.5 cm, were 54% (95% confidence interval, CI: 51-56) and 96% (95% CI: 96-97), respectively; at one hospital, its sensitivity and specificity against a weight-for-height z-score below -3 were 44.7% (95% CI: 42-48) and 96.5% (95% CI: 96-97), respectively. Severely wasted children who were correctly identified by visible severe wasting were consistently older, more severely wasted, more often having kwashiorkor, more often positive to the human immunodeficiency virus, ill for a longer period and at greater risk of death. Visible severe wasting had lower sensitivity for determining the risk of death than the anthropometric measures. There was no evidence to support measuring both MUAC and weight-for-height z-score.
CONCLUSION
Visible severe wasting failed to detect approximately half of the children admitted to hospital with severe acute malnutrition diagnosed anthropometrically. Routine screening by MUAC is quick, simple and inexpensive and should be part of the standard assessment of all paediatric hospital admissions in the study setting.