手足口病患儿复诊住院相关因素分析

Risk factors of return visit for hospitalization in children with hand-foot-mouth disease

目的探讨手足口病（HFMD）患儿再次就诊并收住院相关风险因素及其预测价值。方法2008年5月北京地坛医院集中收治343例HFMD患儿，以其中初诊即回归社区的180例为观察对象。回顾性比较复诊住院（RVH组）患儿与其余病例（对照组）年龄、HFMD接触史、初诊时间、体温、外周血白细胞计数、皮损情况及伴随高危症状。Logistic回归分析探讨患儿RVH可能风险因素及其对RVH的预测价值。结果180例初诊回归社区的患儿中17例（9．44％）因病情未缓解或出现并发症而复诊并收住院，复诊与初诊间隔中位时间为3．26d（0．5—14d）。两组患儿年龄（P=0．669）、性别构成（P=0．101）、HFMD接触史（P=0．104）和病毒分型（P=0．475）差异无统计学意义。RVH组患儿初诊体温（38．74±0．57）℃、发病至就诊间隔时间（3．71±1．10）d、外周血白细胞计数（10．99±3．67）×10^9均显著高于对照组（P〈0．05），并伴有高危症状。多因素分析提示发病至就诊时间超过3d、就诊时体温超过38．5℃、外周WBC〉10．0×10^9和伴有高危症状是RVH的独立风险因素。具有上述3条以上风险因素的患儿RVH率达68．75％（11／16），诊断敏感性64．53％、特异性97．14％。结论初诊时间〉3d、体温〉38．5℃、外周血WBC〉10．0×10^9或伴有高危症状的HFMD患儿应加强监护，独立风险因素达到3项的患儿不应回归社区治疗。

Objective To investigate the risk factors in children with hand-foot-mouth disease （HFMD） hospitalized after the second visit to outpatient department （OPD）, and to evaluate their predictive value. Method In May 2008,180 of 343 pediatric patients with HFMD were repatriated to family or community after preliminary diagnosis in Beijing Ditan Hospital. The ill children hospitalized after revisit （RVH） were compared with the remaining children （ control group） for seeking the differences in age, HFMD contagion, temperature, interval between onset and visit, WBC count, skin lesion and complicating risk symptoms by respective analysis. Logistic regression analysis was performed to find the risk factors involved in patients with RVH and diagnostic evaluation was introducted to predict the probability of R VH. Results Of 180 ill children, 17 （9.44 % ） ones returned to family or community requested admission into hospital for further consultation because who symptoms unremitted or complications developed. The average duration between the preliminary visit and second visit was 3.26 days （0.5- 14 days）. No significant differences were found between RVH group and control group in age （ P = 0.669） ,ratio of gender （P = 0. 101）, contagion with HFMD （P = 0. 104）, and typing of virus （P = 0.475）. Compared with control groups,the significant prolongation of interval between onset and visist （3.71 ± 1.10） d, significant elevation of temperature （38.74 ± 0.57） ℃ and WBC counts （ 10.99± 3.67） × 10^9 were noticed in ill children of RVH （P 〈 0.05）. According to Logistic regression, interval between onset and visit more than 3 days, body temperature at the first visit higher than 38.5℃, WBC count over 10.0× 10^9, and the accompaniment of serious symptoms were confirmed to be independent risk factors involved in RVH. Of tbem,67.85% （11/16） ill children with three or more risk factors of RVH showed diagnosis sensitivity and specificity leach to 64.53 % and 97.14%, respectively. Conclusions Risk factors confirmed are the interval between onset and the visist more than 3 days, body temperature higher than 38.5 ℃ at the first visit, WBC count more than 10.0 × 10^9, and the accompaniment of severe symptoms. The ill children with three or more risk factors are in great request of more closely monitoring and should not be the candidates for repatriation to family or community after preliminary diagnosis.