Clinical predictors of severe head trauma in children

We reviewed the medical records of 55 patients who underwent a cranial computed tomographic (CT) scan for acute head trauma. The severity of head trauma was classified according to objective clinical findings as severe in 44 patients, moderate in three, and mild in eight. Thirty-seven patients (84%) with severe head trauma had a brain injury identified on CT scan. Six patients with severe head trauma had a Glasgow Coma Scale score of 12 or greater and an abnormal CT scan. All patients with mild or moderate head trauma had normal CT scans. Severe head trauma, as defined in this study, accurately identified all patients with abnormal CT scan findings. We conclude that a classification based on objective clinical findings accurately identifies the severity of head trauma. This is particularly important in evaluating patients with a Glasgow Coma Scale score of 12 or greater. A prospective study including larger numbers of patients is needed to further evaluate such a classification.     

Clinical predictors of respiratory syncytial virus infection in children

Aim: The aim of this study was to develop a clinical prediction model that identifies respiratory syncytial virus (RSV) infection in infants and young children.
Methods: Children ≤ 36 months of age with respiratory illness, who were suspected of having RSV infection, were enrolled in this prospective cohort study during the study period between January and February 2002. RSV testing was performed on all patients.
Results: Of the 197 patients enrolled in the study, 126 (64%) were positive for RSV and 71 (36%) patients were either negative for RSV or had a positive culture for viruses other than RSV. The mean age of patients was 5 months and 57% were male. Backwards stepwise logistic regression analysis identified cough (p = 0.000), wheezing (p = 0.002), and retractions (p = 0.008) as independent variables predictive of RSV infection. The prediction model had a sensitivity of 80% (95% CI, 71–87%), specificity of 68% (95% CI, 54–79%), positive predictive value 82% (95% CI, 74–89%), negative predictive value 66% (95% CI, 52–77), positive likelihood ratio 2.5 (95% CI, 1.8–3.7) and post-test probability of 82%.
Conclusion: The combination of cough, wheezing and retractions predicts RSV infection in infants and young children.     

Clinical predictors of acute bacterial diarrhea in young children

This prospective study assessed the value of presenting history, physical examination, and screening laboratory tests in predicting whether diarrhea in a young child is associated with a stool culture positive for a bacterial pathogen. Acutely ill children less than 4 years old were studied in a hospital outpatient setting. Two hundred patients were seen in a 9 1/2-month period, which encompassed the seasons of summer, fall, and winter. One hundred ninety-five patients had cultures completed and twenty-nine (15%) had a bacterial pathogen isolated. The best predictive variable for a stool culture positive for a bacterial pathogen was the presence of polymorphonuclear cells in the stool, with a sensitivity of 85%, a specificity of 88%, and positive and negative predictive values of 59% and 97%, respectively. A cluster of three historical variables--abrupt onset of diarrhea, greater than four stools per day, and no vomiting before the onset of diarrhea--was identified that delineated a subpopulation of patients with an increased probability of having a stool culture positive for a bacterial pathogen (27% v 4% if any of the three variables was absent). It is suggested that these findings can be combined in a stepwise manner using the historical cluster as an initial screening, followed by examination for stool polymorphonuclear cells in the high probability subgroup, to identify those patients with a very high probability of having a bacterial pathogen isolated in their stool.     

小儿流行性感冒的临床特点和诊断要点

流行性感冒 (简称流感 )是由流感病毒引起的急性呼吸道传染病。其特点是起病急 ,传染性强 ,流行广泛 ,传播迅速 ,易引起流行和大流行。小儿流感的临床特点既与流感病毒 (ＩＦＶ)的特性有关 ,又与小儿年龄和免疫状况以及流行情况有关。一、小儿流感的临床特点1.小儿对流感比成人更具普遍易感性 ,并可反复患病。我国自 1988年以来人群中出现的主要是Ｈ3Ｎ2亚型病毒 ,武汉曾分离出Ａ/武汉 /35 9/95毒株 ,这是当前流感的病原。成人患甲型流感后 1周可获得同型病毒免疫力 ,2～ 3周达高峰 ,1～ 2个月后开始下降 ,1年左右降至最低水平。流感恢复期…     

儿童流感合并塑型支气管炎的临床特征分析

目的 分析儿童流感合并塑形支气管炎（PB）的临床特征,提高对流感病毒所致PB的诊治认识。方法 选取2018年10月至2019年10月发生下呼吸道流感病毒感染患儿70例为研究对象,按照是否合并PB分为流感合并PB组（n=12）和流感未合并PB组（n=58）。收集并记录两组患儿的一般资料、临床表现、实验室检查、影像学表现、治疗及预后,进行回顾性分析。结果 流感合并PB患儿中,1~5岁为高发年龄;1月、2月、7月、9月为高发季节;以发热、咳嗽、气促为主要表现;流感合并PB组患儿气促、过敏性疾病（哮喘等）发生率高于流感未合并PB组（P < 0.05） ;12例患儿中,甲型流感病毒感染7例（58%）,乙型流感病毒感染5例（42%）,其中1例存在肾病综合征基础疾病;流感合并PB组患儿影像学以肺部实变伴不张、模糊高密度浸润影、胸腔积液和纵膈气肿为主要表现。流感合并PB组患儿入住PICU率较流感未合并PB组显著升高（P < 0.05）;入院1周内行支气管镜灌洗术,予以抗感染和对症支持治疗,均好转出院。结论 流感合并PB起病急、进展快,尽早行支气管镜检查十分重要。流感患儿表现出气促及存在哮喘等过敏性疾病或肾病综合征基础疾病,应警惕PB的发生。     

Clinical predictors of mucormycosis in children with type 1 diabetes mellitus

BACKGROUND: Mucormycosis is an acute, often rapidly fatal fungal infection that is an important cause of death in young patients with diabetes mellitus (DM) who have poor glycemic control and acute ketosis. Despite the importance of this condition, the clinical predictors of mucor infection are not well defined. METHODS: A retrospective chart review was carried out for five patients, age 14-19 years, diagnosed with mucormycosis at the University of Florida between 1984 and 1999. For the three patients for whom adequate information was available, two randomly selected, age-matched case controls were selected and compared to affected patients for the following variables: average HbA1c concentrations, number of missed clinic appointments, and the number of hospital and Diabetes Project Unit (DPU) admissions. RESULTS: HbA1c levels were similar in affected patients and controls, indicating glycemic control is not the principal factor predisposing to mucor infection. African-American race and poor compliance, as evidenced by poor clinic attendance, risk-taking behaviors and high admission rate to the DPU, were predictors of increased susceptibility to infection with mucormycosis.     

Clinical predictors of bloodstream infections and mortality in hospitalized Malawian children

BACKGROUND: In sub-Saharan Africa, bloodstream infections (BSI) are a major cause of pediatric mortality. Because of limited resources and facilities in these developing countries, treatment often must be based solely on clinical observations and patient history and includes the use of broad spectrum antimicrobials, a factor in the emergence of antibiotic resistance. METHODS: During July 28 through August 18, 1998 we analyzed clinical, epidemiologic and microbiologic data from a cohort of 225 hospitalized children in Malawi, Africa, to determine clinical indices associated with the presence/absence of BSI and/or mortality for use in settings with minimal microbiologic laboratory and intensive care facilities. RESULTS: BSI (n = 35 children) were associated with malnutrition, chronic cough, lethargy by history, lethargy on examination and oral thrush; 92% of children without these symptoms were BSI-negative. Mortality (21 of 173 children with known mortality status) was associated with malnutrition, lethargy on examination, prior receipt of antimalarials and acute decreased feeding. Of those with > or =2 of these indices 69% died; of those with <2 of the indices 94% survived. Infection with human immunodeficiency virus was not significantly related to either BSI or mortality status. CONCLUSIONS: Malnutrition, but not HIV, was strongly related to both BSI and mortality. Assessment of these BSI and mortality indices at hospital admission provides rapid, cost-free indication of which children are most/least in need of empiric antimicrobial therapy or intensive observation, thereby maximizing appropriate use of antimicrobials and limited facilities while minimizing inappropriate antimicrobial usage.     

Clinical features as predictors of functional status in children with cystic fibrosis

Previous clinical studies in patients with cystic fibrosis have demonstrated substantial variability in the symptoms present at diagnosis and in subsequent survival rates. In this study we assessed the association between features present at diagnosis and the clinical course of cystic fibrosis in 89 patients. The 5- and 10-year outcomes for children with cystic fibrosis were better than has been generally appreciated. Overall, two thirds of the patients had either improved or remained at the same level of morbidity 5 years after diagnosis. Children who presented with isolated gastrointestinal symptoms had a good clinical course; some actually improved clinically during the first 5 to 10 years after diagnosis. In contrast, children who presented with respiratory disease frequently had clinical deterioration during the follow-up period. Neither age at presentation nor the initial level of morbidity was significantly related to subsequent outcome. We conclude that clinical features apparent at diagnosis are valuable prognostic indicators in children with cystic fibrosis.     

儿童禽流感

1 禽流感病毒 禽流感是由A型流感病毒引起的一种传染性疾病。最早的禽流感记录是1879年在意大利，发生鸡群大量死亡，当时被称为鸡瘟。直到1955年被科学家证实是A型流感病毒所致。禽流感发现100多年以来，世界各地不断有疫情出现。自2003年以来，亚洲禽流感疫情不断，已有多个国家和地区爆发了大规模的禽流感流行，造成数百万只家禽死亡或被宰杀，还引起人类发病。而且随着甲型禽流感病毒感染区域的不断扩大，越来越多的人群处于禽流感的威胁之中。     

小儿流行性感冒的治疗

流行性感冒 (以下简称流感 )是反复危害社会和人类的重要传染病之一。 1918年“西班牙流感”造成全球 2 0 0 0多万人死亡。 1933年人类发现了甲型流感病毒 ,之后对其认识不断深化 ,但全球依然在195 7年、1968年和 1977年暴发 3次源自我国的流感大流行。更使人们惊恐的是 1997年香港发生了禽流感流行 ,造成 6人死亡 ,15 0多万只鸡禽被宰杀。为什么人类对流感病毒如此无奈 ?这除了病毒本身极易变异外 ,缺乏针对性强、高效抗流感病毒的药物也是一个重要原因。人们对流感缺乏认识和警惕 ,甚至误以为流感就是重感冒 ,丧失发病早期病因治疗的关键…     

儿童乙型流感相关危重症三例临床分析

目的 了解儿童乙型流感相关危重症的临床特点.方法 对我院2007年12月31日至2008年1月7日收治的3例乙型流感病毒感染危重患儿的临床资料进行描述分析.结果 3例患儿乙型流感病毒抗原及核酸检测阳性.1例4岁女童咳嗽起病,合并肺炎链球菌血流感染,病程7d时因重症肺炎、感染性休克、多器官功能衰竭死亡.3岁男童干咳1个月,发热、咳喘1d发展为严重哮喘持续状态、Ⅱ型呼吸衰竭、气漏综合征、上消化道出血,住院治疗12d康复出院.7岁男童咳嗽12d因发生广泛肺间质纤维化而出现低氧血症,对氧持续依赖,病情呈现慢性经过,肾上腺糖皮质激素疗效不明显.结论 乙型流感病毒感染可引起儿童呼吸系统严重并发症.     

荧光免疫层析技术在儿童甲型流感诊断中的临床价值

目的 评价一种新型荧光免疫层析技术在快速检测甲型流感病毒中的价值。方法 2015年7~8月累计收集378例有流感样症状患儿的鼻咽拭子样本,采用荧光免疫层析法,检测鼻咽拭子样本中是否有甲型流感病毒,同时使用胶体金法进行对比检测,所有样本使用RT-PCR验证上述两种检测方法的正确率。结果 378例患儿中,经RT-PCR法检出81例甲型流感病毒阳性,阳性检出率为21.4%;与RT-PCR法相比,荧光免疫层析法与胶体金法的灵敏度分别为90.1%（73/81）、75.3%（61/81）,特异性分别为99.3%（295/297）、98.3%（292/297）。荧光免疫层析法检测为阳性的样本平均Ct值（30.6）大于胶体金法检测为阳性的样本平均Ct值（28.7）。结论 与胶体金法相比,采用荧光免疫层析法检测鼻咽拭子样本中的甲型流感病毒具有更高的检测灵敏度和特异性,与RT-PCR法的一致性更好,能够满足临床上对于准确、早期检测甲型流感病毒的需求。     

Behavioral predictors of injury in school-age children

The behavior of 10,394 British children was related prospectively to their injury history between ages 5 and 10 years, obtained from parents. Aggressive and overactive behaviors at age 5 years were measured by subscales of the Rutter Child Behavior Questionnaire completed by the parents. Multivariate techniques were used to assess the association between behavior and injuries while controlling for social, demographic, and psychological characteristics. Boys' behavior at age 5 years was more strongly predictive of injuries in the subsequent five years than was girls' behavior. The odds of experiencing injuries resulting in hospitalization in boys with high aggression scores was 2.4 times that of boys with low aggression scores. The identification of high-risk children provides the foundation for understanding the behavioral mechanisms that contribute to injuries and for developing preventive strategies tailored to the needs of these children.