发热危险度评分在门诊无明显感染灶发热婴幼儿中的应用研究

临床儿科杂志 ›› 2014, Vol. 32 ›› Issue (1): 38-42.

发热危险度评分在门诊无明显感染灶发热婴幼儿中的应用研究

朱怿东¹ 周剑峰² 柴建农¹ 徐咏梅¹ 夏小红¹

1. 江苏省常熟市第一人民医院儿科（江苏常熟　215500）；
2. 江苏省常熟市中医院（江苏常熟　215500）

收稿日期:2013-05-03 出版日期:2014-01-15 发布日期:2014-01-15

Application of fever risk score in children aged 3 months to 5 years having acute fever without obvious infection focus　ZHU Yidong¹, ZHOU Jianfeng², CHAI Jiannong¹, XU Yongmei¹, XIA Xiaohong¹ (1.Department of Pediatrics, Changshu No.1 People's Hospital, Changshu 215500, Jiangsu, China; 2.Changshu Traditional Chinese Medical Hospital, Changshu 215500, Jiangsu, China)

Received:2013-05-03 Online:2014-01-15 Published:2014-01-15

摘要/Abstract

摘要：

　目的　评估发热危险度评分对指导门诊处理无明显感染灶急性发热儿童的临床价值。方法　根据发热时间、生活状况、每日退热药应用次数、毛细血管再充盈时间、外周血白细胞计数、中性粒细胞计数、C反应蛋白值建立发热危险度评分表，前瞻性评估并随访体温≥38°C无明显感染灶的3个月~5岁急性发热儿童839例，计算该评分的灵敏度、特异度及阳性和阴性预测值。结果　839例患儿中发热危险度评分0分者94例，均无严重疾病，皆居家治疗，其中使用口服抗生素24例（25.54%）；评分1~3分者474例，诊断严重疾病141例，留观或住院治疗112例（23.63%），其中使用抗生素248例（52.32%）；评分≥4分者271例，诊断严重疾病167例，危重症17例，全部住院或留观治疗，其中使用抗生素250例（92.25%）。0~3分组和≥4分组严重疾病发生率、抗生素使用率差异均有统计学意义（P均<0.01）。发热危险度评分≥1分对严重疾病的诊断灵敏度为100%，特异度17.70%，阴性预测值100%，阳性预测值41.34%；评分≥4分对严重疾病的诊断灵敏度为100%，特异度69.10%，阴性预测值100%，阳性预测值6.27%。结论　发热危险度评分可为门诊3个月~5岁无明显感染灶急性发热儿童的病情判断提供参考。

Abstract: 　Objective　To discuss the clinical value of fever risk score in evaluation of acute fever children without obvious infection focus aged 3 months to 5 years. Methods The fever risk score was composed of fever duration, living status, daily frequency of antipyretic administration, capillary refill time, periphery white blood count, neutrophil count, C reaction protein. A total of 839 children aged 3 months to 5 years with acute fever (body temperature ≥38℃) without obvious infection focus were evaluated prospectively by fever risk score and followed up. The sensitivity, specificity, positive and negative predictive values of fever risk score were calculated. Results Among 839 children, 94 children with a score of 0 had no serious disease and were treated at home, and antibiotics were orally administered in 24 children (25.54%). Among 474 children having the scores of 1~3, 141 children were diagnosed with serious illnesses, 112 children (23.63%) were hospitalized or under observation and 248 children (52.32%) were given antibiotics. Among 271 children having the score of 4, 167 children were diagnosed with serious illnesses and 17 with critical illnesses, 271 children (100%) were hospitalized or under observation and 250 children (92.25%) were given antibiotics. There were significant differences in incidence of serious illness and usage rate of antibiotics between children with scores of 0~3 and ≥ 4 (P<0.01). If score ≥ 1 was set as cut point, the sensitivity, specificity, negative predictive value, and positive predictive value for diagnosing serious diseases were 100%, 17.70%, 100% and 41.34%, respectively. If score ≥ 4 was set as cut point, the sensitivity, specificity, negative predictive value, and positive predictive value for diagnosing critical illnesses were 100%, 69.10%, 100% and 6.27%, respectively. Conclusions The fever risk score may be an available, easy-to-use tool to evaluate the condition of acute fever without obvious infection focus in children aged 3 months to 5 years for clinic doctors.

朱怿东周剑峰柴建农徐咏梅夏小红. 发热危险度评分在门诊无明显感染灶发热婴幼儿中的应用研究[J]. 临床儿科杂志, 2014, 32(1): 38-42.

参考文献

[1] National Institute for Health and Clinical Excellence. Feve-rish illness：assessment and initial management in children younger than 5 years [M/OL].[2013-05-03] London (UK)：RCOG Press；2007.www.nice.org.uk/CG047.
[2] 王艺，万朝敏. 中国0至5岁儿童病因不明的急性发热诊断处理指南(标准版) [J]. 中国循证儿科杂志，2008，3(6)：449-457.
[3] 中华急诊医学会儿科学会急救学组.第4届全国小儿急救医学研讨会纪要 [J]. 中华儿科杂志，1995，33(4)：371-373.
[4] Baraff LJ. Management of fever without source in infants and children [J]. Ann Emerg Med. 2000，36(6)：602-614.
[5] Crocetti M，Moghbeli N，Serwint J，et al. Fever phobia revisited：have parental misconceptions about fever changed in 20 years? [J]. Pediatrics，2001，107(6)：1241-1246.
[6] Harper MB，Fleisher GR. Occult bacteremia in the 3-month-old to 3-year-old age group [J]. Pediatr Ann，1993，2(8)：487-493.
[7] Baraff LJ，Bass JW，Fleisher GR，et al. Practice guideline for the management of infants and children 0 to 36 months of age with fever without source. Agency for Health Care Policy and Research [J]. Ann Emerg Med，1993，2(7)：1198-1210.
[8] Baraff LJ. Management of fever without source in infants and children [J]. Ann Emerg Med, 2000，6(6)：602-614.
[9] Baraff LJ，Oslund S，Prather M. Effect of antibiotic therapy and etiologic microorganism on the risk of bacterial meningitis in children with occult bacteremia [J]. Pediatrics, 1993，2(1)：140-143.
[10] Jones RG，Bass JW. Febrile children with no focus of infection：a survey of their management by primary care physicians[J]. Pediatr Infect Dis J, 1993，2(3)：179-183.
[11] Baraff LJ. Management of infants and children 3 to 36 months of age with fever without source [J]. Pediatr Ann, 1993，22(8)：497-498.
[12] Kramer MS，Shapiro ED. Management of the young febrile child：a commentary on recent practice guidelines [J]. Pediatrics，1997，100(1)：128-134.
[13] Strait RT，Kelly KJ，Kurup VP. Tumor necrosis factor-alpha，interleukin-1 beta，and interleukin-6 levels in febrile，young children with and without occult bacteremia [J]. Pediatrics，1999，104(6)：1321-1326.
[14] Van den Bruel A，Haj-Hassan T，Thompson M，et al. Diagnostic value of clinical features at presentation to identify serious infection in children in developed countries：a syste- matic review [J]. Lancet, 2010，375(9717)：834-845.
[15] Baraff LJ. Management of infants and young children with fever without source [J]. Pediatr Ann，2008，37(10)：673-679.
[16] Elshout G ，Monteny M，Wouden J C ，et al. Duration of fever and serious bacterial infections in children：a systematic review [J]. BMC Fam Pract,?2011，12：33.
[17] 中华医学会儿科学分会急救学组中华医学会急诊学分会儿科组《中华儿科杂志》编挥委员会.儿科感染性休克(脓毒性休克)诊疗推荐方案 [J]. 中华儿科杂志，2006，44(8)：596-598.
[18] Van den Bruel A，Thompson M J，Haj-Hassan T，et al. Diagnostic value of laboratory tests in identifying serious infections in febrile children：systematic review [J]. BMJ, 2011，342：d3082.