比色卡提高医生对陶土色大便识别的调查研究

Evaluations of infant stool color card in detecting discolored stools by physicians

目的了解大便比色卡能否提高医生对陶土色大便的识别率及医生对胆道闭锁的认知情况。方法采用自行设计的电子问卷对儿童保健科医生进行问卷调查。问卷中列出12张大便照片,包括5张正常婴儿大便和7张胆道闭锁患儿的陶土色大便,提供大便比色卡比对前后,请医生辨认颜色正常大便或不正常大便,同时调查胆道闭锁相关知识。结果共收集问卷200份,参与问卷调查者来自国内24个省市的医疗单位,90名(45.0%)医生首次能正确识别出所有陶土色大便。仅有113名(56.5%)医生接诊黄疸患儿时关注大便颜色,87名(43.5%)医生接诊黄疸患儿较少或不关注大便颜色,96名(48.0%)医生对胆道闭锁这个疾病不熟悉,50名(25.0%)医生错误地认为胆道闭锁以间接胆红素升高为主,104名(52.0%)医生未听说过大便比色卡。在提供大便比色卡比对后,儿童保健科医生识别陶土色大便照片为异常大便的总体比例从81.9%提高到93.8%,并且对于图1中的2号、3号、6号、9号、11号陶土色大便照片正确识别率均有明显提高(P<0.05)。经过大便比色卡对比后,三级医院儿童保健科医生识别陶土色大便照片为异常大便的总体比例从83.7%提高到93.1%(P<0.05);一、二级医院儿童保健科医生识别陶土色大便照片为异常大便的总体比例从80.3%提高到94.4%(P<0.05)。按医生职称分为主治医师及以下组和副主任医师及以上组,经过大便比色卡对比后,两组医生对陶土色大便正确识别率明显升高(P<0.05)。结论儿童保健科医生对胆道闭锁认识和警惕性不足,大便比色卡能提高医生对陶土色大便的正确识别率,推广大便比色卡的应用及加强对于胆道闭锁基础知识的宣传及学习非常必要。

Objective To evaluate the effect of infant stool color card (ISCC) on recognizing discolored stools and enhance the awareness of biliary atresia (BA) by child healthcare physicians. Methods Child healthcare physicians were surveyed by self-designed questionnaires in November 2017.A total of 12 stool pictures were listed in the questionnaires,including 5 stool pictures of normal infants and 7 discolored stool pictures of BA children.These stool pictures were classified as “normal” or “abnormal” before and after using ISCC.Basic profiles and relevant data of BA were collected. Results A total of 200 questionnaires were collected from child healthcare physicians from 24 provinces.And 90 (45.0%)physicians recognized all discolored stools,only 113 (56.5%) physicians asked about the color of stool when they received jaundice children,87(43.5%) physicians were less concerned with color of stool or seldom treated jaundiced children,96 (48.0%) physicians were not familiar with BA,50(25.0%) physicians misdiagnosed BA as elevated indirect bilirubin and 104(52.0%) physicians had never heard about ISCC.After using ISCC,the overall recognition ratio of clay-earth stools increased from 81.9% to 93.8%.And the correct recognition ratios rose markedly ( P <0.05).The hospitals were divided into classes A,B and C.After using ISCC,physicians at Class A hospitals had an overall recognition rate rising from 83.7% to 93.1%( P <0.05);for physicians at Classes B and C,it increased from 80.3% to 94.4%( P <0.05).When divided into attending/below and associate chief/above,two groups had a markedly increased ratio after using ISCC ( P <0.05). Conclusion Children healthcare practitioners have poor awareness and vigilance of BA.And ISCC can help them recognize discolored stools.It is necessary to promote the application of ISCC,strengthen its promotion and learn the basic knowledge of BA.