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录音中的急性咳嗽特征能区分儿童常见的呼吸系统疾病么?一项比较性的前瞻研究

2020/10/14

   摘要
   背景:急性呼吸系统疾病在世界范围内造成相当大的发病率,咳嗽是这些儿童呼吸系统疾病中的常见症状,但目前没有大量的队列数据来说明各种咳嗽特征是否可以区分这些病因。
   研究问题:是否可以使用各种基于临床的咳嗽特征(频率[白天/夜间],声音本身或类型[干/湿])来区分小儿急性咳嗽的常见病因(哮喘、细支气管炎、肺炎及其他急性呼吸道感染)?
   研究设计和方法:在2017年至2019年期间,纳入了因咳嗽、细支气管炎、肺炎、其他急性呼吸道感染住院的2w至16岁儿童或对照。除了对照组自愿提供三次咳嗽外,24小时内的自发性咳嗽都被数字记录。提取咳嗽并确定频率(咳嗽/每小时)。由两名对临床数据不知情的观察员独立评估咳嗽声音和咳嗽类型。通过一致性(科恩卡伯系数κ),敏感性和特异性,呼吸专家讲咳嗽与出院诊断进行比较。照护者报告的咳嗽评分与使用Spearman系数(rs)的客观咳嗽频率相关。
   结果:该研究纳入了148名儿童(n=118名患有呼吸系统疾病,n=30作为对照组),中位年龄=2.0岁(四分位间距0.7、3.9),其中有58%的男性和50%的第一民族儿童。在患者有呼吸系统疾病的患者中,护理人员报告的咳嗽评分和湿性咳嗽声(42-63%)相似。呼吸专家与出院诊断之间的总体诊断一致性很小(κ=0.13,95%CI 0.03,0.22)。在诊断中,特异性(8-74%)和敏感性(53-100%)不同。盲测中咳嗽类型(湿/干)的评分者一致性几乎是完美的(κ=0.89,95%CI 0.81,0.97)。客观咳嗽频率与使用视觉模拟评分(rs=0.43,偏差校正95%CI 0.25,0.56)和言语分类描述日间评分(rs=0.39,偏差校正95%CI 0.22,0.54)报告的咳嗽评分显著相关。
   解释:单纯的咳嗽特征不足以准确区分儿童中常见的急性呼吸系统疾病。


 
(中日友好医院呼吸与危重症医学科 张清 摘译 林江涛 审校)
(Chest. 2020 Jul 9;S0012-3692(20)31869-9. doi: 10.1016/j.chest.2020.06.067.)


 
 
 
Can Acute Cough Characteristics From Sound Recordings Differentiate Common Respiratory Illnesses in Children?: A Comparative Prospective Study
 
Nina Bisballe-Müller, Anne B Chang , Erin J Plumb , Victor M Oguoma , Susanne Halken , Gabrielle B McCallum 
 
Abstract
Background: Acute respiratory illnesses cause substantial morbidity worldwide. Cough is a common symptom in these childhood respiratory illnesses, but no large cohort data are available on whether various cough characteristics can differentiate between these causes.
Research question: Can various clinically based cough characteristics (frequency [daytime/ nighttime], the sound itself, or type [wet/dry]) be used to differentiate common causes (asthma, bronchiolitis, pneumonia, other acute respiratory infections) of acute cough in children?
Study design and methods: Between 2017 and 2019, children aged 2 weeks to 16 years, hospitalized with asthma, bronchiolitis, pneumonia, other acute respiratory infections, or control subjects were enrolled. Spontaneous coughs were digitally recorded over 24 hours except for the control subjects, who provided three voluntary coughs. Coughs were extracted and frequency defined (coughs/h). Cough sounds and type were assessed independently by two observers blinded to the clinical data. Cough scored by a respiratory specialist was compared with discharge diagnosis using agreement (Cohen's kappa coefficient [қ]), sensitivity, and specificity. Caregiver-reported cough scores were related with objective cough frequency using Spearman coefficient (rs).
Results: A cohort of 148 children (n = 118 with respiratory illnesses, n = 30 control subjects), median age = 2.0 years (interquartile range, 0.7-3.9), 58% males, and 50% First Nations children were enrolled. In those with respiratory illnesses, caregiver-reported cough scores and wet cough (range, 42%-63%) was similar. Overall agreement in diagnosis between the respiratory specialist and discharge diagnosis was slight (қ = 0.13; 95% CI, 0.03-0.22). Among diagnoses, specificity (8%-74%) and sensitivity (53%-100%) varied. Interrater agreement in cough type (wet/dry) between blinded observers was almost perfect (қ = 0.89; 95% CI, 0.81-0.97). Objective cough frequency was significantly correlated with reported cough scores using visual analog scale (rs = 0.43; bias-corrected 95% CI, 0.25-0.56) and verbal categorical description daytime score (rs = 0.39; bias-corrected 95% CI, 0.22-0.54).
Interpretation: Cough characteristics alone are not distinct enough to accurately differentiate between common acute respiratory illnesses in children.
 


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