Otitis media: Can clinical findings predict bacterial or viral etiology?
Otitis media: Can clinical findings predict bacterial or viral etiology?
复制标题
DOI：
10.1097/00006454-200003000-00019
复制
发表时间：
2000-03-01
影响因子：
3.6
通讯作者：
Chonmaitree, T
中科院分区：
文献类型：
--
作者：
McCormick, DP;Lim-Melia, E;Chonmaitree, T
方法.患者评估。我们从儿科诊所招募了 AOM 儿童，进行 AOM 辅助治疗的研究（结果稍后报告）。本报告中包含的数据是在注册时以及注册后第 3 至 5 天收集的。如果儿童被临床诊断为 AOM 并且家长签署了我们机构审查委员会批准的知情同意书，我们将其纳入其中。如果儿童患有耳部或鼻咽部缺陷、重大疾病、入组后 7 天内针对任何适应症接受过抗生素治疗、入组前 30 天内接受过 AOM 治疗或进行鼓室置管术，则儿童被排除在外。每次就诊时，我们都会要求家长按照李克特三点量表从 0（无）到 2（严重）对九种症状进行评分（发烧、耳痛（拉扯）、烦躁、喂食不良、鼻漏、鼻塞、咳嗽、打喷嚏和流泪）。这九个分数的总和构成了总症状分数。由于原始症状集中包含许多非特异性特征，因此我们创建了一个症状子评分，其中包含我们观察到的幼儿 AOM 更具体的四个关键特征：发烧（< 38 C= 0、38–39 C= 1、> 39 C= 2）、耳痛（无= 0、偶尔= 1、频繁= 2）、烦躁（无= 0、偶尔= 1、频繁= 2）和喂养不良（无= 0，轻度= 1，严重= 2）。为了验证子分数，我们比较了入组时的前后分数与第 3 至 5 天的分数。通过从预分数中减去后分数来计算每个科目的差异。发烧、耳痛/拉扯、烦躁和喂养不良的组合被证明是入组和第 3 天至第 5 天之间关键症状变化的有力衡量标准（访问 1 平均得分 = 4.44±1.8，访问 2 平均得分 = 0.73±1.3，n = 27，用于检验总体平均值为 0 的假设的学生 t 检验值；P = 0.0001）。
Methods.Patient assessment. We enrolled children with AOM from the pediatric clinic for a study of adjuvant therapy in the treatment of AOM (results to be reported later). Data included in this report were gathered at enrollment and on Days 3 to 5 postenrollment. We included children if they had a clinical diagnosis of AOM and if the parent had signed an informed consent approved by our institutional review board. Children were excluded if they had defects of the ear or nasopharynx, a major medical condition, antibiotic treatment for any indication within 7 days of enrollment, treatment of AOM within 30 days before enrollment or tympanostomy tubes. At each visit we asked parents to rate nine symptoms [fever, ear ache (tugging), irritability, poor feeding, rhinorrhea, nasal stuffiness, cough, sneezing and watery eyes] on a three-point Likert scale from 0 (none) to 2 (severe). The sum of these nine scores comprised the total symptom score. Because a number of nonspecific features were included in the original symptom set, we created a symptom subscore consisting of the four key features that we observed to be more specific for AOM in young children: fever (< 38 C= 0, 38–39 C= 1,> 39 C= 2), ear ache (none= 0, occasional= 1, frequent= 2), irritability (none= 0, occasional= 1, frequent= 2) and poor feeding (none= 0, mild= 1, severe= 2). To validate the subscore we compared pre and post scores at enrollment vs. Days 3 to 5. A difference was calculated for each subject by subtracting the post from the pre score. The combination of fever, ear ache/tugging, irritability and poor feeding proved a robust measure of change in key symptoms between enrollment and Days 3 to 5 (Visit 1 mean score= 4.44±1.8, Visit 2 mean score= 0.73±1.3, n= 27, Student's t test value for testing the hypothesis that the population mean was 0; P= 0.0001).