儿童发热家长评价表临床应用研究

Clinical Application of Scale of Parental Assessment of Fever in Children

目的探讨适合家长的、对无明显感染灶的儿童急性发热的评价方法。方法选取2009年12月—2014年12月于常熟市第一人民医院和常熟市中医院儿科门诊就诊的符合纳入标准的发热患儿家长237例为研究对象。制定儿童发热家长评价表,对家长及医师进行培训,家长按儿童发热评价表内容自评,然后决定就诊或与结对医师取得联系。记录患儿一般情况和家长复诊原因。其中一般情况包括入组前后发热事件、使用抗生素情况、治疗情况(居家治疗、静脏滴注)、复诊情况、严重疾病发生情况、危重疾病发生情况、最后诊断。结果 237例患儿中,51例未能完成随访予以剔除,剩余186例。患儿入组前共发生发热事件336例次,其中严重疾病19例次(5.7%),未发生危重疾病;最后诊断前3位分别为急性上呼吸道感染181例次(53.9%),支气管炎67例次(19.9%),幼儿急疹32例次(9.5%)。患儿入组后共发生发热事件592例次,其中严重疾病65例次(11.0%),未发生危重疾病;最后诊断前3位分别为急性上呼吸道感染356例次(60.1%),支气管炎102例次(17.2%),幼儿急疹69例次(11.7%)。患儿入组前后发热事件中使用抗生素、治疗、复诊情况比较,差异均有统计学意义(P<0.05)。426例次复诊患儿中,因为儿童发热家长评价表中A原因复诊114例次(26.8%),B原因108例次(25.4%),C原因101例次(23.7%),D原因78例次(18.3%),E原因25例次(5.9%)。结论儿童发热家长评价表能够较好地帮助家长正确处理无明显感染灶的儿童急性发热,减少不必要的医院就诊、抗生素使用和静脉滴注,又能保证医疗安全。

Objective To develop an appropriate method for parents to assess the acute fever in children without obvious infection focus. Methods 237 fever children who visited the Department of Pediatrics of＇Changshu No. 1 People＇ s Hospital and Changshu Hospital of TCM from December 2009 to December 201.4 and met th~ criteria were selected. We developed the Scale of Parental Assessment of Fever in Children and trained the parents and doctors on the use of it, and the corresponding procedure was as follows： parents firstly assess the severity of fever in children based on the guidance of the scale, then determine whether to see a doctor or contact the twinned doctor. The general conditions including fever events occurred before and after the application of the scale, use of antibiotics, treatment （ domestic management and transfusion ） , information of return visits, incidence of severe disease, incidence of critically illness and final diagursis of the children and reasons of return visits were recorded. Results As 51 of the 237 children failed to complete fellow - up and were excluded from the study, the final sample consisted of 18＇6 children. Before the use of the scale, 336 times of fever events occurred in the 186 cases, including 19 times of severe disease onset （5.7%）, but no critically illness occurred. In terms of onset frequencies, the result of final diagnosis showed that the top 3 diseases were acute upper respiratory infection （ 181, 53.9% ）, bronchitis （67, 19. 9% ）, and exanthema subitum （32, 9. 5% ） . After the use of the scale, totally 592 times of fever events occurred in the 186 cases, including 65 times of severe disease onset （ 11.0% ） , but no critically illness occurred. The result of final diagnosis indicated that acute upper respiratory infection had the most attack frequencies （356, 60. 1% ）, followed by bronchitis （ 102, 17.2% ）, and exanthema subitum （69, 11.7% ） . The aspects of use of antibiotics, treatment and return visits before and after the application of the scale were statistically significant （P 〈0. 05） . Of the 426 return visits, 114 （26. 8% ） were due to reasons of category A listed in the Scale of Parental Assessment of Fever in Children, 108 （25.4%） due to category B, 101 （23.7%） due to category C, 78 （18.3%） due to category D, and 25 （5.9%） due to category E. Conclusion The Scale of Parental Assessment of Fever in Children may help parents properly manage the acute fever in children without obvious infection focus, which decreases the unnecessary visits, use of antibiotics and transfusion as well as ensures medical safety.