哮喘延迟诊断对胸片和临床抗生素使用的影响
2012/02/29
目的：在儿童中评价哮喘诊断的时效性对胸片（CXR）和抗生素使用的影响。
患者与方法：明尼苏达州罗切斯特的276名年龄为5～12岁的哮喘患儿入选本项回顾性队列研究。自儿童满足制定的哮喘诊断标准起，记录其针对呼吸系统疾病进行的CXR和抗生素使用的频率，直至其18岁。采用Poisson回归模型，比较哮喘及时诊断、哮喘延迟诊断和无哮喘诊断者之间CXR和抗生素的使用频率。
结果：276名哮喘患者中，97名（35%）及时诊断，122名（44%）有延迟诊断，而57名（21%）无临床哮喘诊断。在针对呼吸系统疾病进行的CXR和抗生素的使用频率上，各组之间无显著差异。此外，及时诊断和延迟诊断（包括哮喘延迟诊断和从未有哮喘诊断）组之间也无显著性差异。
结论：儿童哮喘延迟诊断较为普遍，总体来说，这不会影响临床医生针对呼吸系统症状的抗生素使用和CXR检查。然而，这可能对哮喘相关治疗和其他卫生资源利用产生影响，但在本研究中并未进行评价。基于本研究的局限性，有必要进行前瞻性试验研究。
患者与方法：明尼苏达州罗切斯特的276名年龄为5～12岁的哮喘患儿入选本项回顾性队列研究。自儿童满足制定的哮喘诊断标准起，记录其针对呼吸系统疾病进行的CXR和抗生素使用的频率，直至其18岁。采用Poisson回归模型，比较哮喘及时诊断、哮喘延迟诊断和无哮喘诊断者之间CXR和抗生素的使用频率。
结果：276名哮喘患者中，97名（35%）及时诊断，122名（44%）有延迟诊断，而57名（21%）无临床哮喘诊断。在针对呼吸系统疾病进行的CXR和抗生素的使用频率上，各组之间无显著差异。此外，及时诊断和延迟诊断（包括哮喘延迟诊断和从未有哮喘诊断）组之间也无显著性差异。
结论：儿童哮喘延迟诊断较为普遍，总体来说，这不会影响临床医生针对呼吸系统症状的抗生素使用和CXR检查。然而，这可能对哮喘相关治疗和其他卫生资源利用产生影响，但在本研究中并未进行评价。基于本研究的局限性，有必要进行前瞻性试验研究。
（苏楠 审校）
J Asthma. 2012 Feb;49(1):23-8. Epub 2011 Dec 7.
J Asthma. 2012 Feb;49(1):23-8. Epub 2011 Dec 7.
Source
Division of Community Pediatric and Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic , Rochester, MN, USA.
Division of Community Pediatric and Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic , Rochester, MN, USA.
Abstract
OBJECTIVE：To evaluate the effect of the timeliness of asthma diagnosis on chest X-ray (CXR) and antibiotic utilization in children.
PATIENTS AND METHODS：This was a retrospective cohort study of 276 asthmatic children aged 5-12 years from Rochester, Minnesota. From the time when children met our predetermined asthma criteria, the frequency of CXR and antibiotic utilizations for respiratory illnesses were collected from medical records until age 18 years. Using a Poisson regression model, the frequency of CXR and antibiotic utilizations were compared in children with timely, delayed, or no clinician diagnosis of asthma.
RESULTS：Of the 276 asthmatic patients, 97 (35%) had a timely diagnosis, 122 (44%) had a delayed diagnosis, while 57 patients (21%) had no clinician diagnosis of asthma. There was no significant difference in CXR or antibiotic utilization for respiratory illness between these groups. In addition, this was true for the comparison between the timely diagnosed group and the delayed diagnosed group combining both the group with a delay in asthma diagnosis and the group who never had asthma diagnosis.
CONCLUSIONS：A delay in the diagnosis of asthma in children is common and overall it may not influence antibiotic and CXR utilization for respiratory symptoms by clinicians. However, its impact on access to asthma-related therapies and other healthcare utilizations could be possible and was not assessed in this study. Given the limitations of our study, a larger prospective study needs to be considered.
OBJECTIVE：To evaluate the effect of the timeliness of asthma diagnosis on chest X-ray (CXR) and antibiotic utilization in children.
PATIENTS AND METHODS：This was a retrospective cohort study of 276 asthmatic children aged 5-12 years from Rochester, Minnesota. From the time when children met our predetermined asthma criteria, the frequency of CXR and antibiotic utilizations for respiratory illnesses were collected from medical records until age 18 years. Using a Poisson regression model, the frequency of CXR and antibiotic utilizations were compared in children with timely, delayed, or no clinician diagnosis of asthma.
RESULTS：Of the 276 asthmatic patients, 97 (35%) had a timely diagnosis, 122 (44%) had a delayed diagnosis, while 57 patients (21%) had no clinician diagnosis of asthma. There was no significant difference in CXR or antibiotic utilization for respiratory illness between these groups. In addition, this was true for the comparison between the timely diagnosed group and the delayed diagnosed group combining both the group with a delay in asthma diagnosis and the group who never had asthma diagnosis.
CONCLUSIONS：A delay in the diagnosis of asthma in children is common and overall it may not influence antibiotic and CXR utilization for respiratory symptoms by clinicians. However, its impact on access to asthma-related therapies and other healthcare utilizations could be possible and was not assessed in this study. Given the limitations of our study, a larger prospective study needs to be considered.
J Asthma. 2012 Feb;49(1):23-8. Epub 2011 Dec 7.
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伏立康唑和泊沙康唑能改善过敏性支气管肺曲菌病和真菌致敏的严重哮喘患者的哮喘严重程度
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哮喘异质性和治疗选择：从临床到实验室
