小儿可疑呼吸道异物诊断方法的敏感度及特异度比较

Sensitivities and specificities of diagnostic criteria in children with suspicious foreign body aspiration

目的拟从病史、体征及影像学检查等方面对小儿呼吸道异物的诊断方法进行敏感度和特异度的比较。方法回顾性分析340例患儿的病历资料,根据文献及临床经验制定出病史、体征及影像学检查的阳性标准,支气管镜检查的结果为"金标准",分别计算上述各指标的灵敏度、特异度、阳性预测值及阴性预测值。对同时接受X线和CT检查的患儿进行两种检查方法的符合率和吻合度比较。结果病史、体征、X线检查及CT检查的灵敏度及阳性预测值都较高,特异度和阴性预测值较低;CT和X线检查与术中所见的符合率比较差异无统计学意义。结论当患儿出现以上指标中单一指标阳性时,可以选择支气管镜探查。对于可疑呼吸道异物的患儿,可以首选包括透视在内的X线检查。

OBJECTIVE The aim of this study was to evaluate the sensitivities and specif icities of clinical history, physical examination and chest X-ray f indings and /or chest CT f indings in child ren with suspicious foreign body in airway. METHODS The medical records of 340 child ren were reviewed for clinical history, physical examination and chest X-ray findings and chest CT findings. The positive criteria of above four methods were based on literature and clinical experience. The finding of bronchoscopy was considered as 'gold standard'. Then we calculated the sensitivities, specificities, positive predictive value(PPV) and negative predictive value(NPV) of above four methods. Thirtyseven children were underwent both chest X-ray and CT s c a n. T h e a c c u r a t e r a t e of c h e s t X- r a y f i n d i n g s a nd che st C T f i nd i ng s we r e c omp a r e d. R E SU LTS The sensitivities and PPV of above four methods were higher, but the specificities and NPV were lower. There were no sig nif icant difference of the accu rate rate between the chest X-ray findings and chest CT findings. CONCLUSION If any of the above four methods were positive, bronchoscopy should be done. Chest X-ray(including fluoroscopy) is the first diagnostic choice for suspicious cases.