Diagnostic value of signs, symptoms and diagnostic tests for diagnosing pneumonia in ambulant children in developed countries: a systematic review.
Diagnostic value of signs, symptoms and diagnostic tests for diagnosing pneumonia in ambulant children in developed countries: a systematic review.
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DOI：
10.1038/s41533-018-0104-8
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发表时间：
2018-10-26
影响因子：
3.1
通讯作者：
Cals JWL
中科院分区：
文献类型：
--
作者：
Schot MJC;Dekker ARJ;Giorgi WG;Hopstaken RM;de Wit NJ;Verheij TJM;Cals JWL
对于初级保健医生来说，在一大群患有急性呼吸道感染的儿童中识别出患有肺炎的儿童可能是一项挑战。关于特定体征和症状的诊断价值的知识可以指导临床医生未来的决策规则和指南。我们的目的是确定并系统地审查现有证据，以证明体征、症状和额外测试对发达国家门诊儿童肺炎的诊断价值。我们进行了系统回顾，并在 PubMed 和 Embase 的电子数据库中进行了检索。使用 QUADAS-2 标准对研究进行质量评估。从选定的研究中提取数据后，我们计算并总结了所有可用体征、症状、额外实验室测试和胸部超声检查的测试特征（敏感性、特异性、阴性和阳性预测值）。最初的搜索产生了 4665 条记录，其中 17 篇文章符合分析条件：12 篇关于体征和症状的研究，4 篇关于其他实验室测试的研究，6 篇关于超声检查的研究。所有纳入的研究都是在二级保健机构中进行的。大多数患者选择领域的研究都存在偏倚风险。肺炎患病率从 3.4% 到 71.7% 不等。现有的 27 种个体体征和症状对肺炎的诊断价值较低。在低患病率环境中（4 项研究，肺炎患病率 <10%），儿童的临床症状和氧饱和度 <94% 可以为医生提供帮助。在高患病率环境中（10 项研究，肺炎 >10%），额外的诊断测试（例如氧饱和度、C 反应蛋白和白细胞计数）更有希望。胸部超声检查在肺炎患病率较高的地区显示出较高的诊断价值。来自病史和体格检查的单一体征和症状或单独的附加诊断测试不足以诊断流动儿童的肺炎。很少有诊断研究是在肺炎患病率较低的环境中进行的。低患病率环境中的未来研究应侧重于临床特征和可能使用个体数据荟萃分析的额外测试相结合的诊断价值。
Identifying a child with pneumonia in the large group of children with acute respiratory tract infections can be challenging for primary care physicians. Knowledge on the diagnostic value of specific signs and symptoms may guide future decision rules and guidelines for clinicians. We aimed to identify and systematically review available evidence for the diagnostic value of signs, symptoms, and additional tests to diagnose pneumonia in children in an ambulatory setting in developed countries. We conducted a systematic review, searching in the electronic databases of PubMed and Embase. Quality assessment of studies was done using the QUADAS-2 criteria. After data extraction from selected studies, we calculated and summarized test characteristics (sensitivity, specificity, negative and positive predictive values) of all available signs, symptoms, additional laboratory tests, and chest ultrasonography. The original search yielded 4665 records, of which 17 articles were eligible for analysis: 12 studies on signs and symptoms, 4 on additional laboratory tests, and 6 on ultrasonography. All included studies were performed in a secondary care setting. Risk of bias was present in the majority of studies in the domain of patient selection. Prevalence of pneumonia varied from 3.4% to 71.7%. The diagnostic value of the available 27 individual signs and symptoms to identify pneumonia was low. In a low prevalence setting, (4 studies, pneumonia prevalence <10%) clinically ill appearance of the child and oxygen saturation <94% can aid a physician. In a high prevalence setting (10 studies, pneumonia >10%), additional diagnostic tests such as oxygen saturation, C-reactive protein, and white blood cell count are more promising. Chest ultrasonography showed high diagnostic value in settings with higher prevalence of pneumonia. Single signs and symptoms from medical history and physical examination or individual additional diagnostic tests are insufficient to diagnose pneumonia in ambulant children. Very few diagnostic studies are conducted in settings with low prevalence of pneumonia. Future research in low prevalence settings should focus on the diagnostic value of the combination of clinical features and additional testing possibly using meta-analysis of individual data.
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影响因子：
2.6
作者：
Ianniello, Stefania;Piccolo, Claudia Lucia;Miele, Vittorio
通讯作者：
Miele, Vittorio
影响因子：
2.2
作者：
Dekker, Anne R. J.;Verheij, Theo J. M.;van der Velden, Alike W.
通讯作者：
van der Velden, Alike W.
影响因子：
1.6
作者：
Mahabee-Gittens, EM;Grupp-Phelan, J;Slap, GB
通讯作者：
Slap, GB
影响因子：
105.7
作者：
Craig, Jonathan C.;Williams, Gabrielle J.;McCaskill, Mary
通讯作者：
McCaskill, Mary
影响因子：
8
作者：
Hersh, Adam L.;Shapiro, Daniel J.;Shah, Samir S.
通讯作者：
Shah, Samir S.