Precisión de la taquipnea y las retracciones subcostales como signos clínicos para diagnóstico de neumonía adquirida en la comunidad en niños: revisión sistemática y metaanálisis

Domecq, Juan Pablo; Prutsky, Gabriela; Lazo, Maria; Salazar, Carlos; Montori, Víctor M.; Prevost, Yolanda; Huicho, Luis; Erwin, Patricia J.; Málaga, Germán

doi:10.1590/s1726-46342012000300007

Cited by 3 publications

(4 citation statements)

References 22 publications

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“…In this study it was observed that the kappa index showed statistical significance (p value < 0.05) for the presence of at least a reasonable correlation in all segments of cephalic vein (renal or non renal) for segment adequacy by ultrasound criteria, the gold standard of evaluation, pointing to the value of this maneuver in physical examination. Since there is no similar description in the literature on the ability of venous percussion to diagnose an adequate superficial venous segment of upper limbs suitable for venous puncture or for arteriovenous fistula construction, a comparison of the results found in this study with previous studies of clinical signs in different clinical situations[25–32], found that the indices regarding traditional physical examinations techniques such as pulmonary auscultation were inferior to the ones found in this study[25]. This provides evidence for including venous percussion in a traditional physical examination, as part of the triage done during physical examination, and, maybe with further studies, on already existing scales for difficult venous access [3,33].…”

Section: Discussionmentioning

confidence: 86%

“…Analysis of the sensitivity, specificity and diagnostic accuracy of a clinical sign in a structured and systematic way enables identification of possible forms of assisting diagnosis of clinical conditions in a simple manner. From the point of view of public health, this can have a real impact on the logistics of diagnosis on remote areas of undeveloped countries as has been demonstrated in cases of community-acquired pneumonia in children[29,30,32].…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of upper limb superficial venous percussion as a sign of anatomical location and venous permeability. A comparative study of superficial venous percussion to ultrasound findings on non-renal patients and on chronic kidney disease patients

et al. 2019

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The objective of this study was to evaluate venous percussion in the upper limbs as a possible low-cost clinical sign that may contribute to physical examination of the superficial venous system and be useful in the evaluation for punctures and also for the construction of fistulas.MethodsAn analytical cross-sectional study with 70 individuals divided into two groups. Group A consisted of 35 volunteers who were being preoperatively prepared for the construction of arteriovenous fistula. Group B consisted of 35 non-renal patients selected by convenience. Each participant underwent physical examination, including venous percussion, of the dominant upper limb and then ultrasound. Interobserver agreement was assessed between a trained vascular surgeon performing percussion and fourth-year medical student. Accuracy, sensitivity, specificity, positive predictive value and negative predictive value of percussion were determined in relation to ultrasound. The agreement between the methods, venous percussion and venous duplex ultrasound was also evaluated by the Kappa index.ResultsThe overall interobserver agreement for the percussion was 0.74 (95% CI 0.632 to 0.851). It was observed that the results were more favorable in the cephalic vein than in the basilic vein, emphasizing that the cephalic is more used in venous punctures, because of its anatomical location and visibility, and in fistula construction. The 35 percussions of the cephalic forearm vein in Group A resulted in a sensitivity of 1.0 (95% CI 0.63 to 1.00), specificity of 0.96 (95% CI 0.81 to 1.00), a positive predictive value of 0.89(95% CI 0.52 to 1.00) and a negative predictive value of 1.00 (95% CI 0.87 to 1.00), with an accuracy of 0.97 (95% CI 0.85 to 1.00) and Kappa index of 0.92 (95% CI 0.77 to 1.00) in relation to ultrasound. Overall, when all venous segments were analyzed in group A, the Kappa index of agreement between the percussion and the ultrasonography reached 0.56 (95% CI 0.401 to 0.72). All venous segments in Group A had a sensitivity of 0.54 (95% CI 0.37 to 0.70) and a specificity of 0.96 (95% CI 0.90 to 0.99). When all venous segments were analyzed in group B, the Kappa index of agreement between the percussion and the ultrasonography reached 0.48 (95% CI 0.34 to 0.62). All venous segments in Group B had a sensitivity of 0.70 (95% CI 0.59 to 0.79) and a specificity of 0.82 (95% CI 0.69 to 0.91).ConclusionVenous percussion of the upper limbs has a high positive predictive value and high specificity, when compared to ultrasound as a way to evaluate the patency and adequacy of the cephalic vein. Although there is not enough evidence to preclude ultrasound, percussion should definitely be included in the traditional physical exam evaluation of upper limbs superficial veins.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Evaluation of upper limb superficial venous percussion as a sign of anatomical location and venous permeability. A comparative study of superficial venous percussion to ultrasound findings on non-renal patients and on chronic kidney disease patients

et al. 2019

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“…The presence of coughing and tachypnea, mainly among patients with previous history of wheezing, was not pathognomonic of pneumonia. 16 However, the association of tachypnea, SCS 17 and NF 18 increased the chances of CAP diagnosis, especially if the patient presented coughing and fever. The presence of SCS in more than half of the cases evaluated illustrates the severity of the clinical framework in the diagnosis of children attended in the emergency research service.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and outcomes of acute community acquired pneumonia in children at a reference public hospital in Pernambuco State, Brazil (2010-2011)

Brito

Guerra

Câmara

et al. 2016

Rev. Bras. Saude Mater. Infant.

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Objectives: to describe the clinical characteristics and outcomes of acute community acquired pneumonia in children at a reference public hospital in Pernambuco State, Brazil (2010-2011) Methods: pneumonia case series of 80 children aged 28 days to 14 years old at Hospital da Restauração in Pernambuco, Brazil, from 2010 to 2011. Information was noted from medical files, and two comparison groups were created according to the severity of the disease, considering the presence of pleural effusion. Fisher or Mann-Whitney tests were used for comparative analyses. Results: severe pneumonia with pleural effusion was more frequent in children under five years of age (p=0,025), and was associated with longer period of fever (19 x 15 days) and coughing (17 x 13 days), when compared to non-complicated pneumonia cases. Six children (7,5%, 6/80) died, 50% before the fourth day of hospitalization (p=0,001). All deaths were from the pleural effusion group in children from the countryside (p=0,026). Conclusions: the severity of pneumonia in children attended at this hospital is related to younger children, and those transferred from the health units in the countryside, so, early diagnosis and medical intervention are limited by infrastructure and available resources for the health.

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“…A nivel local no se han realizado estudios que describan la realidad epidemiológica, por eso es necesaria la investigación sobre esta patología. Se estima que cada año, 150 millones de niños y niñas desarrollan la enfermedad y 11 millones de niños son hospitalizados a causa de neumonía y casi todos ellos viven en países en vías de desarrollo; por cada niño que pierde la vida a causa de neumonía en un país desarrollado, más de 2.000 mueren en un país en vías de desarrollo [1][2][3][4][5][6][7][8][9][10][11][12].…”

Section: Introductionunclassified

Estudio Transversal: Neumonía Adquirida en La Comunidad en Niños

Peñafiel¹,

Valverde²,

Reyes

et al. 2016

Rev Med HJCA

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INTRODUCCIÓN: La neumonía adquirida en la comunidad (NAC) afecta a una gran parte de la población infantil, se encuentra entre las primeras causas de morbilidad y mortalidad en este grupo con predominio de los menores de 5 años; el objetivo del presente estudio fue obtener la prevalencia de NAC y describir sus características clínicas, mortalidad y complicaciones. MÉTODO: El presente trabajo es un estudio descriptivo y retrospectivo que incluyó a los pacientes ingresados al Servicio de Pediatría del HJCA-IESS, y de ellos se seleccionaron a los que fueron diagnosticados con NAC durante el año 2013 para describir sus características clínicas, sociodemográficas y complicaciones. Los datos se obtuvieron a partir de las historias clínicas de los pacientes. Para el análisis de la información se utilizó la estadística descriptiva y medidas de tendencia central. RESULTADOS: Se registraron 123 casos de neumonía (prevalencia de 15%), por sexo el más afectado fue el masculino, la media de edad de los pacientes fue de 27.33 meses, los pacientes del área urbana fueron los más afectados con el 61%, el grupo etario más afectado fue de 1 a 4 años (47.96%), la desnutrición representó el 8.9%, el estado nutricional no se asoció con la estancia hospitalaria (P > 0.05) y la media de hospitalización fue de 8.2±6.2 días. CONCLUSIÓN: La NAC es más frecuente en niños de 1 a 4 años; tiene una prevalencia, tasa de mortalidad y complicaciones similares a la presentadas por la bibliografía. El diagnóstico depende fundamentalmente de la anamnesis y examen físico, sin embargo los estudios complementarios aportan con valiosa información.

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Precisión de la taquipnea y las retracciones subcostales como signos clínicos para diagnóstico de neumonía adquirida en la comunidad en niños: revisión sistemática y metaanálisis

Cited by 3 publications

References 22 publications

Evaluation of upper limb superficial venous percussion as a sign of anatomical location and venous permeability. A comparative study of superficial venous percussion to ultrasound findings on non-renal patients and on chronic kidney disease patients

Evaluation of upper limb superficial venous percussion as a sign of anatomical location and venous permeability. A comparative study of superficial venous percussion to ultrasound findings on non-renal patients and on chronic kidney disease patients

Clinical characteristics and outcomes of acute community acquired pneumonia in children at a reference public hospital in Pernambuco State, Brazil (2010-2011)

Estudio Transversal: Neumonía Adquirida en La Comunidad en Niños

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