【Cochrane简语概要】急诊科儿童急性发热性呼吸道疾病的病毒快速诊断

本综述的研究问题 

在急诊科进行快速病毒检测是否影响有发热和呼吸相关症状儿童的治疗？

研究背景 

年龄在0至18岁的健康儿童，因发烧和呼吸相关症状而入院，住进急诊科（EDs），目前是医疗保健系统的主要负担，对父母和护理人员来说都会造成严重的焦虑，产生巨大的开支。当医生不确定疾病的病因并担心可能会因此开具抗生素处方时，他们通常会先进行诊断检测，同时考虑严重的细菌感染的可能性。然而，在大多数情况下，发烧和呼吸相关症状是由病毒导致的。此外，在发现病毒是致病原因的儿童中，严重细菌感染的风险极低。因此，我们进行这一综述，旨在能够评价在急诊科进行快速病毒检测是否会改变对这些儿童的疗法。

（图片来源于网络）

研究特征 

我们回顾了截止到2014年7月的研究。我们纳入了4项前瞻性对照研究，研究对象是无病史的18岁以下儿童，他们因发烧和呼吸相关症状而前往急诊科就诊。

主要结果 

这四项研究 共纳入759名研究受试者，我们发现，无病史的儿童在出现发烧和呼吸相关症状时，采取过快速病毒检测后，可有抗生素处方开具减少的趋势，但这一发现在统计学上没有意义。然而，我们发现病毒快速检测可以减少胸部X射线的使用。还可以对比采用血液和尿液检查的使用情况。但是，确定这种干预措施对血液和尿液检测频率以及急诊就诊时间的实际影响，需要基于儿童的大样本临床试验。所有纳入的研究均未报告与试验干预措施相关的伤害或不良事件。

证据质量 

由于存在偏倚风险、间接性、不精确性、发表偏倚和不一致性的风险，证据的质量被评定为中等。虽然没有研究采用盲法，但使用快速病毒检测的意义在于其能够提供诊断信息。这种干预措施对临床医生采用盲法是不可能的，并使干预无效。

结论: 

没有足够的证据支持常规的快速病毒检测能够减少儿科急诊中抗生素的使用。快速病毒检测可能降低也可能不降低抗生素使用率及其他检查（尿检和血检）；这些研究并没有提供足够证据来回答这个问题。然而，快速病毒测试确实降低了急诊科中胸部X光的使用率。仍需要有足够把握度，且以抗生素使用为结局指标的试验。

相关文章链接

【Cochrane Plain Language Summary】Rapid viral testing for children in the Emergency Department with fever and respiratory symptoms

Review question 

Does rapid viral testing in the Emergency Department influence the treatment of children with fever and breathing symptoms?

Background 

Otherwise healthy children, aged 0 to 18 years, admitted to Emergency Departments (EDs) with fever and respiratory symptoms represent a major burden to the healthcare system, as well as significant anxiety and expense to parents and caregivers. Physicians often order diagnostic tests and may prescribe antibiotics when they are unsure of the cause of the illness and are concerned about the possibility of serious bacterial infection. However, in most cases, fever and respiratory symptoms are caused by viruses. In addition, in children in whom a virus is found to be the cause of their illness, the risk of serious bacterial infection is very low. We conducted this review to assess whether a rapid viral test, done in the ED, changes what physicians do when treating these children.

Study characteristics 

We reviewed studies retrievable as of July 2014. We included four prospective controlled studies of previously healthy children under 18 years of age who attended an ED of an urgent care clinic because of fever and respiratory symptoms.

Key results 

Based on these four studies, involving 759 study participants, we found that in previously healthy children coming to the ED with fever and respiratory symptoms, a rapid viral test showed a trend towards fewer antibiotic prescriptions, but this finding was not statistically significant. However, we found that rapid viral testing reduces the use of chest X-rays. There are also blood and urine investigations that can be undertaken. The true impact of this intervention on the frequency of blood and urine testing, as well as the length of the ED visit, requires trials with larger numbers of children. None of the included studies reported harm or adverse events related to the intervention tested.

Quality of the evidence 

The quality of the evidence was considered moderate with regard to risk of bias, indirectness, imprecision, publication bias and inconsistency. While none of the studies used blinding, the impact of the use of rapid viral testing is in its ability to provide diagnostic information. Blinding of this interventions to the clinician would be impossible and make the intervention useless.

Authors' conclusions: 

There is insufficient evidence to support routine rapid viral testing to reduce antibiotic use in pediatric EDs. Rapid viral testing may or may not reduce rates of antibiotic use, and other investigations (urine and blood testing); these studies do not provide enough power to resolve this question. However, rapid viral testing does reduce the rate of chest X-rays in the ED. An adequately powered trial with antibiotic use as an outcome is needed.

译者：关英杰；审校：鲁春丽；编辑排版：张晓雯，北京中医药大学循证医学中心

想要报名成为Cochrane翻译志愿者，查看更多内容，请关注公众号了解详情！

中医循证医学摇篮，传播循证理念方法，彰显中医优势特色，促进中医药国际化。

长按识别二维码，关注我们

点击“阅读原文”，查看中英文完整摘要。