小儿科医师诊断与处理急性鼻窦炎的回顾


  January 30, 2009 — 二月号小儿科期刊上的一项调查回顾了由小儿科医师诊断与处理急性鼻窦炎,回顾中探讨不同的症状、使用鼻窦影像检查、以及急性鼻窦炎的处理,包括抗生素的选择,以及应急的处方药使用。
  
  来自科罗拉多州奥罗拉科罗拉多丹佛大学的Lon McQuillan医师与其同事们表示,急性鼻窦炎是小儿常见的诊断,这占了绝大多数抗生素的使用量;然而,对于小儿科医师如何诊断与处理小儿非严重性急性鼻窦炎所知仍有限。
  
  这项研究的目的在于了解小儿科医师如何评估与治疗小儿非严重性急性鼻窦炎。
  
  研究人员在2007年6月到8月,从美国医学会资料库中随机挑选750位一般小儿科医师进行邮寄问卷调查,有271位小儿科医师完成这项普查,回覆率为45%。
  
  小儿科医师们回报急性鼻窦炎诊断的病患年龄层介于0至5个月的有6%、6至11个月的有17%、12至23个月的有36%、24至35个月的有21%、36个月以上的有20%。
  
  在急性鼻窦炎诊断上,被小儿科医师视为极严重的症状,包括症状持续时间较长(93%)、化脓性流鼻涕(55%)、以及鼻塞(43%);症状持续的时间被60%小儿科医师视为比症状组合来得重要,小儿科医师认为符合标准的症状持续时间为1到6天的有3%、7到9天为17%、10到13天为37%、14到16天为38%、17天以上有6%。
  
  研究作者们写到,我们发现小儿科医师开始考虑诊断非严重性急性鼻窦炎的年龄差异很大,大部分小儿科医师考虑症状持续时间是最重要的诊断因子。
  
  普查结果显示,为了诊断急性鼻窦炎,超过一半的(58%)小儿科医师表示至少偶而会使用到断层扫描。
  
  96%受访者「经常」或「总是」处方抗生素,且53%受访者至少「偶而」或是更常使用应急性抗生素处方;其它被报告「经常」或「总是」使用的方法包括生理食盐水冲洗(44%)、全身性解鼻塞药物(28%)、鼻腔类固醇(20%)与全身性抗组织胺(13%)。
  
  研究作者们写到,虽然临床上进行鼻窦计算机断层检查仍有限制,但大部分的小儿科医师对非严重症状小儿病患做了这项检查;目前使用应急性抗生素非常普遍,在小儿病患身上使用全身性解鼻塞药物与抗组织氨药物很常见,美国食品药物管理局表示需要重新检验,对于其安全性的执业方式。
  
  这项研究的限制包括可能的回应误差以及/或是回忆性误差,对于回报的信赖程度、非实际执业等等。
  
  研究作者们的结论是,小儿科医师报告诊断方法上的差异,代表需要更强的证据基础来让小儿科医师们进行临床判断。许多小儿科医师对罹患非严重性急性鼻窦炎小儿病患使用应急性抗生素,这是个相关研究数据不多的作法。在此情况下使用应急性抗生素处方,可能是非必要性抗生素使用可以降低的一个重要机转;应进行更多有关于应急性抗生素处方用于小儿病患之非严重性急性鼻窦炎的安全性与疗性的研究。
  
  健康信息与服务主管机关透过国家研究服务奖经费来赞助这项研究;研究作者们表示没有相关资金上的往来。

Acute Sinusitis Diagnosis, Management by Pediatricians Reviewed

By Laurie Barclay, MD
Medscape Medical News

January 30, 2009 — Diagnosis and management of acute sinusitis by pediatricians are reviewed in a survey study reported in the February issue of Pediatrics. The survey considered the importance given to various symptoms, the use of sinus imaging, and management of acute sinusitis, including antibiotic choices and contingency prescription use.

"Acute sinusitis is a common diagnosis in young children and accounts for a substantial amount of antibiotic use," write Lon McQuillan, MD, MSPH, from the University of Colorado Denver in Aurora, Colorado, and colleagues. "However, little is known regarding how pediatricians diagnose and manage nonsevere acute sinusitis in young children."

The goal of this study was to characterize how pediatricians evaluate and treat nonsevere acute sinusitis in otherwise healthy children 6 years or younger.

From June to August 2007, a mail survey was sent to a national random sample of 750 general pediatricians from the American Medical Association Master File. The response rate was 45%, with 271 pediatricians completing the survey.

Patient age at which pediatricians reported first considering the diagnosis of acute sinusitis was 0?to 5 months in 6%, 6 to 11 months in 17%, 12 to 23 months in 36%, 24 to 35 months in 21%, and 36 months or older in 20%.

Symptoms considered by the pediatricians to be "very important" in diagnosing acute sinusitis were prolonged duration of symptoms (93%), purulent rhinorrhea (55%), and nasal congestion (43%). Symptom duration was thought by 60% of pediatricians surveyed to be more important than symptom combination. Symptom durations thought by the pediatricians to be expected before considering the diagnosis were 1 to 6 days (3%), 7 to 9 days (17%), 10 to 13 days (37%), 14 to 16 days (38%), and 17 or more days (6%).

"We found significant variation in the age at which pediatricians begin considering the diagnosis of nonsevere acute sinusitis in children," the study authors write. "Most pediatricians consider symptom duration the most important diagnostic factor."

To diagnose acute sinusitis, more than half (58%) of pediatricians surveyed reported using sinus computed tomography scans at least "occasionally."

Antibiotics were prescribed "frequently" or "always" for acute sinusitis by 96% of respondents, and 53% reported using contingency antibiotic prescriptions at least "occasionally" or more often. Reported use of adjuvant treatments "frequently" or "always" included saline washes (44%), systemic decongestants (28%), nasal corticosteroids (20%), and systemic antihistamines (13%).

"The majority of pediatricians use sinus computed tomography imaging at least occasionally in young children with nonsevere symptoms despite its limitations in this clinical setting," the study authors write. "Although poorly understood, the use of contingency antibiotic prescriptions is common. Lastly, the use of systemic decongestants and antihistamines in young children is reported, a practice that needs to be reexamined in light of recent Food and Drug Administration warnings regarding their safety."

Limitations of this study include possible response bias and/or recall bias, and reliance on report of practice, not actual practice.

"The variety of diagnostic approaches reported by pediatricians speaks to the need for a stronger evidence base on which pediatricians can make clinical decisions," the study authors conclude. "Many pediatricians use contingency antibiotic prescriptions in young children with nonsevere acute sinusitis, a practice for which there are few data. Contingency antibiotic prescription use in this setting may be an important mechanism through which unnecessary antibiotic use can be minimized; data on the safety and effectiveness of contingency prescription use for nonsevere acute sinusitis in young children is needed."

The Health Resources and Services Administration funded this study through a National Research Service Award grant. The study authors have disclosed no relevant financial relationships.

Pediatrics. 2009;123;e193-e198.

    
相关报导
随机控制试验:非复杂性憩室炎可不使用抗生素
2016/10/24 下午 05:46:10
无并发症阑尾炎的孩童可以不用手术
2015/12/29 上午 10:06:27
阑尾炎:使用较长期的抗生素治疗可能没有帮助
2015/12/9 下午 02:53:46

上一页
   1   2   3   4   5   6   7   8   9   10  




回上一页