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背景初级医疗中,儿童发热通常由感染引起,经常引起家长担忧。了解发热的相关信息、持续时间和预测因子可能会使家长安心,进而减少问诊量。目的判断初级医疗发热儿童发热持续的预测标志和症状,探讨C反应蛋白是否对这些症状具有附加预测价值。设计和场所选取一家全科医生合作服务诊所进行前瞻性队列研究。方法纳入经父母描述为发热的儿童(3个月~6岁)。排除标准:无法采用荷兰语交流,在研究前两周内纳入同一研究,在诊所就诊后直接入院,不同意参与本研究。主要医疗结局为首次就诊后持续发热(多于3 d)。结果共纳入480名儿童,持续发热患儿占13%(63/480)。结合患儿病史和身体检查结果的多变量分析表明,咽喉痛〔OR=2.8,95%CI(1.30,6.01)〕、淋巴结肿大〔OR=1.87,95%CI(1.01,3.49)〕是持续发热的预测因素,然而该模型预测价值较低(AUC=0.64)。C反应蛋白〔OR=1.00,95%CI(0.99,1.01)〕并非持续发热的预测因素。结论持续发热相关表征和症状较少,C反应蛋白不能准确预测儿童持续发热的发生。
Background In primary care, fever in children is usually caused by an infection, often causing concern to parents. Knowing the relevant information about fever, duration, and predictors may give parents peace of mind, thereby reducing the number of inquiries. Objective To determine the predictive signs and symptoms of persistent fever in children with primary medical fever and to explore whether C-reactive protein has additional predictive value for these symptoms. Design and site Select a GP practice clinic for prospective cohort studies. Methods Inclusion of children described by their parents as fever (3 months to 6 years old). Exclusion Criteria: Unable to communicate in Dutch, include the same study within the first two weeks of the study, be admitted directly to the clinic and not agree to participate in the study. The main medical outcome was sustained fever (more than 3 days) after the first visit. Results A total of 480 children were included, with 13 (63/480) children with persistent fever. Multivariate analysis based on the patient’s history and physical examination showed that sore throat (OR = 2.8, 95% CI 1.30, 6.01), enlarged lymph nodes (OR 1.87, 95% CI 1.01, 3.49) However, the predictive value of this model was lower (AUC = 0.64). C-reactive protein (OR = 1.00, 95% CI (0.99, 1.01)] was not a predictor of persistent fever. CONCLUSIONS: Persistent fever-related signs and symptoms are rare and C-reactive protein can not accurately predict the occurrence of persistent fever in children.