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世界核心医学期刊文摘（儿科学分册） 2005年第11期1卷 22-23页

作者： Steinhoff M.C. walker C.F. rimoin a.w. Ham-za H.S. 郭战宏 615 N. wolfe Street Baltimore MD 21205 United States

Background: Most of the world’s children live in regionswhere laboratory facilities are not available. In these regions, clinical prediction rules can be useful to guide clinicians’decisions on antibiotic therapy for streptococcal pharyngitis, and to reduce routine presumptive antibiotic therapy for all pharyngitis. Methods: Prospective cohort study to assess diagnostic signs and develop a prediction rule. Bivariate and multivariate analyses were used to develop clinical rules. Participants were 410 children in Cairo, Egypt, aged from 2 to 12 y, presenting with complaint of sore throat and whose parents provided consent. Main outcome measures included presence of signs and symptoms, and positive group A beta hemolytic streptococcal (GABHS) culture. Results: 101 (24.6%) children had positive GABHS culture. Pharyngeal exudate, tender or enlarged anterior cervical lymph nodes, season, absence of rash, or cough or rhinitis were associated with positive culture in bivariate and multivariate analyses. Three variables (enlarged nodes, no rash, no rhinitis), when used in a cumulative score, showed 92%sensitivity and 38%specificity in these children. Conclusions: The proposed three-variable clinical prediction rule for GABHS may be useful when diagnostic laboratories are not available. In this setting, the rule identified more than 90%of true cases. Compared to universal treatment of all pharyngitis, the rule will reduce antibiotic use in GABHS-negative cases by about 40%.

关键词：链球菌性咽炎临床决策检查设备临床预测皮疹消退咽部分泌物前瞻性队列研究颈前淋巴结淋巴结增大儿童生活

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对链球菌性咽炎的wHO临床诊断规则的评价

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世界核心医学期刊文摘（儿科学分册） 2006年第A3期2卷 35-35页

作者： rimoin a.w. Hamza H.S. Vince A. 贺莉 Department of Epidemiology UCLA School of Public Health 650 Charles E.Young Drive SouthLos AngelesCA 90095-1772 United States

Aims: To prospectively assess the wHO clinical decision rule (CDR) for group A beta haemolytic streptococcal (GABHS)-pharyngitis in three countries. Methods: A prospective, observational cohort study in urban outpatient clinics in Rio de Janeiro, Cairo, and Zagreb. There were 2225 children aged 2-12 years with cough, rhinorrhoea, red or sore throat; 1810 of these with sore throat were included in the analysis. Results: The proportion of children presenting with sore throat and found to have GABHS pharyngitis ranged from 24.6% (Brazil) to 42.0% (Croatia). wHO CDR sensitivity was low for all sites in both age groups. In children age 5 or older, sensitivity ranged from 3.8% in Egypt to 10.8% in Brazil. In children under 5, sensitivity was low(0.0-4.6% ) Specificity was high in both age groups in all countries (93.8-97.4% ). Conclusions: In these populations, the current wHO CDR has high specificity, but low sensitivity; it did not detect up to 96.0% of children who have laboratory confirmed GABHS pharyngitis. A CDR with higher sensitivity should be developed for use in regions where rheumatic fever and rheumatic heart disease are still major health problems.

关键词：链球菌性咽炎 wHO 诊断规则咽部充血 β溶血队列研究风湿性心脏病观察性年龄组特异度

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