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背景:咽炎是一种常见的儿科疾病。如果单纯使用临床化验指标会在许多病例中误诊病原菌。在急诊科, 对儿童咽炎进行非标准化的治疗可能会导致不恰当的经验治疗,结果使细菌抗药性增强,最终可能因为治疗不当而引起副作用。目的:按照循证医学的方针对就诊于儿科急诊的咽炎患儿进行诊断和治疗并指导抗生素的应用。方法:在急诊室建立并实施评估和治疗咽炎的循证医学方针。搜集急诊的临床资料,对干预前后患儿进行队列研究。利用标准化的数据整理表格对临床记录进行汇总,汇总项目包括病史、体格检查记录、诊断性检验和治疗措施。如果β溶血性链球菌性咽炎是根据细菌学检查而不是单纯的病史和体格检查确诊时,认为治疗措施恰当。结果:进入研究共443例患儿(219例为干预前组,224例为干预后组)。干预前组的214例中有97 例(占44%)接受了恰当的治疗。而干预后组224例中有204例(占91%)得到了恰当的治疗。结论:采用循证医学方针能够指导和改善教学医院儿科急诊医师的抗生素使用状况。
Background: Pharyngitis is a common pediatric disease. If the simple use of clinical laboratory indicators misdiagnosis of pathogens in many cases. In the emergency department, a non-standardized treatment of pharyngitis in children may lead to inappropriate empirical treatment, resulting in increased bacterial resistance, which may eventually lead to side effects due to improper treatment. OBJECTIVE: To diagnose and treat children with pharyngitis in pediatric emergency department and to guide the application of antibiotics according to the guidelines of EBM. Methods: Establish and implement evidence-based medical guidelines for the assessment and treatment of pharyngitis in the emergency department. Collect clinical data of emergency department and conduct cohort study on children before and after intervention. Clinical records are summarized using a standardized data set-up table that summarizes the medical history, physical examination records, diagnostic tests, and treatment measures. If beta hemolytic streptococcal pharyngitis is diagnosed on the basis of a bacteriological examination rather than a simple history and physical examination, the treatment is considered appropriate. RESULTS: A total of 443 children were enrolled in the study (219 pre-intervention and 224 post-intervention). 97 of the 214 patients (44%) in the pre-intervention group received the appropriate treatment. In the group of 224 cases after intervention, 204 cases (91%) were properly treated. CONCLUSIONS: The use of evidence-based medicine guidelines can guide and improve the use of antibiotics in pediatric emergency physicians in teaching hospitals.