a systematic review on the diagnosis of pediatric bacterial pneumonia when gold is bronze系统回顾在小儿细菌性肺炎的诊断黄金是铜牌.pdfVIP

A Systematic Review on the Diagnosis of Pediatric Bacterial Pneumonia: When Gold Is Bronze 1 2 3 4 2 2 Tim Lynch , Liza Bialy *, James D. Kellner , Martin H. Osmond , Terry P. Klassen , Tamara Durec , Robin Leicht2, David W. Johnson3 1 Department of Pediatrics, Children’s Hospital, University of Western Ontario, London, Ontario, Canada, 2 Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada, 3 Department of Pediatrics and Physiology and Pharmacology, University of Calgary and Alberta Children’s Hospital, Calgary, Alberta, Canada, 4 Clinical Research Unit, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada Abstract Background: In developing countries, pneumonia is one of the leading causes of death in children under five years of age and hence timely and accurate diagnosis is critical. In North America, pneumonia is also a common source of childhood morbidity and occasionally mortality. Clinicians traditionally have used the chest radiograph as the gold standard in the diagnosis of pneumonia, but they are becoming increasingly aware that it is not ideal. Numerous studies have shown that chest radiography findings lack precision in defining the etiology of childhood pneumonia. There is no single test that reliably distinguishes bacterial from non-bacterial causes. These factors have resulted in clinicians historically using a combination of physical signs and chest radiographs as a ‘gold standard’, though this combination of tests has been shown to be imperfect for diagnosis and assigning treatment. The objectives of this systematic review are to: 1) identify and categorize studies that have used single or multiple tests as a gold standard for assessing ac