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首页> 外文期刊>BMC Pediatrics >Predictors of treatment failure for non-severe childhood pneumonia in developing countries – systematic literature review and expert survey – the first step towards a community focused mHealth risk-assessment tool?
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Predictors of treatment failure for non-severe childhood pneumonia in developing countries – systematic literature review and expert survey – the first step towards a community focused mHealth risk-assessment tool?

机译：发展中国家非严重儿童期肺炎治疗失败的预测指标–系统的文献回顾和专家调查–迈向以社区为中心的mHealth风险评估工具的第一步？

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Background Improved referral algorithms for children with non-severe pneumonia at the community level are desirable. We sought to identify predictors of oral antibiotic failure in children who fulfill the case definition of World Health Organization (WHO) non-severe pneumonia. Predictors of greatest interest were those not currently utilized in referral algorithms and feasible to obtain at the community level. Methods We systematically reviewed prospective studies reporting independent predictors of oral antibiotic failure for children 2–59 months of age in resource-limited settings with WHO non-severe pneumonia (either fast breathing for age and/or lower chest wall indrawing without danger signs), with an emphasis on predictors not currently utilized for referral and reasonable for community health workers. We searched PubMed, Cochrane, and Embase and qualitatively analyzed publications from 1997–2014. To supplement the limited published evidence in this subject area we also surveyed respiratory experts. Results Nine studies met criteria, seven of which were performed in south Asia. One eligible study occurred exclusively at the community level. Overall, oral antibiotic failure rates ranged between 7.8-22.9?%. Six studies found excess age-adjusted respiratory rate (either WHO-defined very fast breathing for age or 10–15 breaths/min faster than normal WHO age-adjusted thresholds) and four reported young age as predictive for oral antibiotic failure. Of the seven predictors identified by the expert panel, abnormal oxygen saturation and malnutrition were most highly favored per the panel’s rankings and comments. Conclusions This review identified several candidate predictors of oral antibiotic failure not currently utilized in childhood pneumonia referral algorithms; excess age-specific respiratory rate, young age, abnormal oxygen saturation, and moderate malnutrition. However, the data was limited and there are clear evidence gaps; research in rural, low-resource settings with community health workers is needed.
机译：背景技术在社区一级，对于患有非严重肺炎的儿童，需要改进的转诊算法。我们试图确定符合世界卫生组织（WHO）非严重肺炎病例定义的儿童口服抗生素失败的预测因素。最引人关注的预测变量是当前在引荐算法中尚未使用且在社区一级可行的预测变量。方法我们系统地回顾了前瞻性研究，这些研究报告了在资源有限的情况下，世卫组织非严重肺炎（无论是年龄的快速呼吸和/或没有危险迹象的下胸壁抽出），在资源有限的环境中对2–59个月大的儿童口服抗生素失败的独立预测因素，重点放在目前尚未用于转诊且对于社区卫生工作者合理的预测变量上。我们搜索了PubMed，Cochrane和Embase，并对1997年至2014年的出版物进行了定性分析。为了补充这一领域中有限的公开证据，我们还对呼吸系统专家进行了调查。结果九项研究符合标准，其中七项在南亚进行。一项合格的研究仅在社区一级进行。总体而言，口服抗生素失败率在7.8-22.9％之间。六项研究发现，年龄调整后的呼吸频率过高（世卫组织定义的非常快的呼吸频率或比正常的世卫组织年龄调整的阈值快10-15次呼吸/分钟），四项研究表明年轻年龄可以预测口服抗生素失败。在专家小组确定的七个预测因素中，异常的血氧饱和度和营养不良是该小组的排名和评论最受青睐的因素。结论本评价确定了儿童肺炎转诊算法中目前未使用的几种口服抗生素失败的预测指标。特定年龄段的呼吸频率过高，年幼，血氧饱和度异常和中度营养不良。但是，数据是有限的，并且有明显的证据空白。需要与社区卫生工作者一起在农村资源匮乏的地方进行研究。

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