摘要
目的对急性发热患者传染病快速识别系统的临床应用进行研究。方法选择2017年10月1日-2017年12月31日于解放军总医院发热门诊就诊的急性发热患者598例,根据传染病的流行病学史、临床特征,经专家评议,建立急性发热患者传染病快速识别系统,由经过严格培训的护士采集相关资料,对患者进行风险等级评估,将评分≥3分定为高风险组,<3分定为低风险组,比较高风险组与低风险组传染病确诊率,分析该评分系统预测传染病的准确性、敏感性等,比较传染病与非传染病患者评分指标、血常规、白细胞介素-6(IL-6)、C-反应蛋白(CRP)等变化。结果根据急性发热患者传染病快速识别系统评分,分为高风险组414例和低风险组184例,高风险组传染病确诊率为77.05%,高于低风险组的49.46%,差异具有统计学意义(P<0.001),该评分系统预测传染病的准确性为68.90%,敏感性为77.80%。传染病与非传染病在旅居史、有皮疹或出血、白细胞计数正常或偏低、血小板下降方面比较差异有统计学意义(P<0.05);传染病患者白细胞计数、中性粒细胞、淋巴细胞、血小板、CRP和IL-6水平,均低于与非传染病,差异均具有统计学意义(P<0.05)。结论急性发热患者传染病快速识别系统可以快速识别急性发热患者是否为传染病,可缩短传染病暴露时间,早期预警,尽快隔离,有一定的临床应用价值。
OBJECTIVE A rapid identification system for infectious diseases in patients with acute fever was established, and its efficiency in clinical application was evaluated. METHODS A total of 598 patients with acute fever who were treated in fever clinic of General Hospital of PLA from Oct 1, 2017 to Dec 31, 2017 were enrolled in the study. The rapid identification system for infectious diseases was established based on the epidemiological history, clinical characteristics and experts’ review, the related data were collected by the rigidly trained nurses so as to conduct the risk grade assessment for the patients. The patients with the score no less than 3 points were assigned as the high risk group, and the patients with the score less than 3 points were set as the low risk group. The diagnosis rate of the disease was compared between the two groups. The sensitivity and specificity of the identification system were also evaluated. Levels of score indexes, blood routine examination, IL-6 and CRP were compared between patients with infection and without infection. RESUILTS Subjects in this study was divided in to the high-risk group(414) and the low-risk group(184) by using the scores of the rapid identification system.The clinical diagnosis rate of infectious diseases in the high-risk group was 77.05%, which was significantly higher than that in the low-risk with the diagnosis rate of 49.46%(P<0.001). The accuracy and the sensitivity of the rapid identification system were 68.90% and 77.80%, respectively. The occurrence rate of the history of travelling, rash, hemorrhage, normal or lower WBC, decreased platelet in the patients with infection disease was significantly higher than that in the patients without infection disease(P<0.05).The number of WBC, Neutrophil, Lymphocyte, platelet and the levels of CRP and IL-6 in the infectious patients were significantly lower than that in the on-infectious patients(P<0.05). CONCLUSION The rapid identification system for infectious diseases in patients with acute fever score could discriminate infective from non-infective fever patients rapidly, which can shorten the exposure time of the infectious disease for the early alert and isolation, and can be applicated in clinical practice.
作者
肖红菊
田琳
祝伟秀
翟永志
闻宇
陈歆
陈刚
赵强
刘运喜
刘刚
XIAO Hong-ju;TIAN Lin;ZHU Wei-xiu;ZHAI Yong-zhi;WEN Y U;CHEN Xin;CHEN Gang;ZHAO Qiang;LIU Yun-xi;LIU Gang(General Hospital of the Chinese Peoples Liberation Army Beijing 100039,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2019年第24期3687-3690,3695,共5页
Chinese Journal of Nosocomiology
基金
解放军总医院临床科研扶持基金资助项目(2015FC-GLCX-1003)
关键词
急性发热
传染病快速识别评分
白细胞介素-6
C-反应蛋白
临床应用
Acute Fever
Rapid identification of infectious diseases in acute febrile patients
Interleukin-6
C-reaction protein
Clinical application
