Heckerling在日本初级保健环境中区分社区获得性肺炎的标准:观察性研究

Q1 Medicine Asia Pacific Family Medicine Pub Date : 2019-01-01 DOI:10.22146/APFM.V18I2.25
Naoto Ishimaru, Satoshi Suzuki, T. Shimokawa, Y. Akashi, Yuto Takeuchi, A. Ueda, Saori Kinami, Hiromichi Suzuki, Y. Tokuda, T. Maeno
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摘要

背景:社区获得性肺炎(CAP)是一种可导致死亡的常见疾病。胸部x光片是确诊肺炎的金标准方法,但可能不必要地使患者暴露在辐射下。Heckerling’s criteria (HC)评分是胸片的有效替代,可用于排除CAP。HC评分≥4强烈提示肺炎,而≤1则表明患者无肺炎。HC评分在西方人群中得到了很好的验证,但在亚洲人群中尚未得到验证。症状的种族差异和体温测量方法的差异可能会影响该人群HC评分的有效性。我们评估在日本初级保健设置HC评分的使用。方法:我们对2016年12月至2018年10月在两家社区医院之一就诊的年龄≥16岁的发热和呼吸道症状患者进行了前瞻性观察研究。我们评估了HC在鉴别CAP患者和非CAP患者中的准确性。肺炎的定义是当患者出现呼吸道症状并在胸部x线或胸部计算机断层扫描上发现新的浸润。结果:341例患者中有296例可分析资料,其中女性37.2%,平均年龄41.1岁。58例(19.6%)被诊断为CAP。HC判别CAP的ROC面积为0.69 (95% CI 0.62 ~ 0.76)。敏感性为0.66 (95% CI 0.52 ~ 0.78) (HC评分≤1),特异性为0.68 (95% CI 0.61 ~ 0.74) (HC评分bbb1)。结论:在我们的日本急性呼吸道疾病病例中,HC未能检测到CAP的病例约占30%。HC评分在非西方人群中应谨慎使用。
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Heckerling’s criteria to distinguish community-acquired pneumonia in a Japanese primary care setting: observational Study
Background: Community-acquired pneumonia (CAP) is a common illness that can lead to mortality. Chest radiographs are the gold standard method of confirmation of pneumonia but could unnecessarily expose patients to radiation. Heckerling’s criteria (HC) scoring is a useful substitute for chest radiographs and can be used to rule out CAP. HC score ≥ 4 is strongly indicative of pneumonia, while ≤ 1 indicates the patient is pneumonia-free. HC scoring is well validated in Western populations, but has not been validated in an Asian population. Racial differences in symptoms and differences in the method of measuring body temperature might affect the validity of HC scoring in this population. We evaluate the use of HC scoring in a Japanese primary care setting. Methods: We conducted a prospective observational study of patients aged ≥ 16 years who had fever and respiratory symptoms in one of two community hospitals between December 2016 and October 2018. We evaluated the accuracy of HC in discrimination of patients with and without CAP. Pneumonia was defined as when patients suffered from respiratory symptoms and had new infiltration recognized on chest X-ray or chest computed tomography. Results: Analyzable data from 296 of 341 patients was available (37.2% were female, mean age: 41.1 years). CAP was diagnosed in 58 patients (19.6%). HC discriminated CAP with ROC area of 0.69 (95% CI 0.62-0.76). Sensitivity was 0.66 (95% CI 0.52-0.78) (HC score ≤ 1) and specificity was 0.68 (95% CI 0.61-0.74) (HC score >1). Conclusions: HC failed to detect CAP in approximately 30% of our Japanese cases presenting acute respiratory illness. HC scoring should be used cautiously in non-Western populations.
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Asia Pacific Family Medicine
Asia Pacific Family Medicine Medicine-Family Practice
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