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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Reliability of clinical examinations for pediatric skin and soft-tissue infections.
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Reliability of clinical examinations for pediatric skin and soft-tissue infections.

机译：儿科皮肤和软组织感染的临床检查的可靠性。

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OBJECTIVE: To determine the interrater reliability of clinical examination by pediatric emergency medicine physicians for the diagnosis of skin and soft-tissue infections (SSTIs). METHODS: A cross-sectional study of patients presenting to a pediatric emergency department with SSTIs was performed. Each lesion was examined by a treating physician and a study physician (from a pool of 62 physicians) at the bedside during the emergency department visit. The primary outcome was reliability, as measured with the weighted kappa statistic, for determining whether the lesion was an abscess and whether the lesion required a drainage procedure. RESULTS: A total of 371 lesions were analyzed for interrater reliability. The weighted kappa value for diagnosis of the lesion as an abscess was 0.39 (95% confidence interval: 0.32-0.47), and that for assessment of the need for drainage was 0.43 (95% confidence interval: 0.36-0.51). Agreement was statistically more likely for lesions in children >/= 4 years of age but was not more likely for lesions in nonblack patients, lesions in patients with a history of or exposure to a close contact with a SSTI, or lesions examined by 2 experienced pediatric emergency medicine physicians. CONCLUSIONS: Among the 62 participating physicians at our site, the reliability of the clinical examination was poor. This may indicate that improved education and/or more-objective means for diagnosing these infections in the acute care setting are warranted. Additional studies are needed to determine whether these results are generalizable to other settings.
机译：目的：确定儿科急诊医师对皮肤和软组织感染（SSTI）的诊断进行临床检查的可靠性。方法：对就诊于小儿急诊科的SSTI患者进行了横断面研究。急诊就诊期间，病床旁的一名治疗医师和一名研究医师（来自62位医师）对每个病变进行了检查。主要结果是可靠性，可以通过加权kappa统计量来确定病变是否为脓肿以及病变是否需要引流。结果：共分析了371个病灶的间位可靠性。诊断为脓肿的加权卡帕值为0.39（95％置信区间：0.32-0.47），而评估引流需求的加权卡帕值为0.43（95％置信区间：0.36-0.51）。从统计学上讲，> / = 4岁儿童的病变更有可能达成一致，但非黑人患者，有SSTI病史或密切接触的患者的病变或由2名经验丰富的患者检查过的病变的可能性较小儿科急诊医学医师。结论：在我们站点的62位参与医师中，临床检查的可靠性较差。这可能表明有必要对急性护理中的这些感染进行更好的教育和/或更具客观性的诊断手段。需要进行其他研究以确定这些结果是否可推广到其他环境。

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