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1、BMJ. 2013; 346:f2450.Publishedonline2013April30. doi: 10.1136/bmj.f2450PMCID: PMC3639712UseofserumCreactiveproteinandprocalcitoninconcentrationsinadditiontosymptomsandsignstopredictpneumoniainpatientspresentingtoprimarycarewithacutecough:diagnostics
2、tudySaskiaFvanVugt, generalpractitioner ,1 BernaDLBroekhuizen, assistantprofessor,1 ChristineLammens, analyst,2NicolaasPAZuithoff, assistantprofessor,1 PimAdeJong, radiologist,3 SamuelCoenen, assistantprofessor,2MargaretaIeven, professor,2 ChrisCButl
3、er, professor,4 HermanGoossens, professor,2 PaulLittle, professor,5 andTheoJMVerheij, professor1, onbehalfoftheGRACEconsortiumAuthorinformation ► Articlenotes ► CopyrightandLicenseinformation ►Goto:AbstractObjectives Toquantifythediagnosticaccuracyof
4、selectedinflammatorymarkersinadditiontosymptomsandsignsforpredictingpneumoniaandtoderiveadiagnostictool.Design Diagnosticstudyperformedbetween2007and2010.Participantshadtheirhistorytaken,underwentphysicalexaminationandmeasurementofCreactiveprotein(CR
5、P)andprocalcitonininvenousbloodonthedaytheyfirstconsulted,andunderwentchestradiographywithinsevendays.Setting Primarycarecentresin12Europeancountries.Participants Adultspresentingwithacutecough.Mainoutcomemeasures Pneumoniaasdeterminedbyradiologists,
6、whowereblindtoallotherinformationwhentheyjudgedchestradiographs.Results Of3106eligiblepatients,286wereexcludedbecauseofmissingorinadequatechestradiographs,leaving2820patients(meanage50,40%men)ofwhom140(5%)hadpneumonia.Re-assessmentofasubsetof1675ches
7、tradiographsshowedagreementin94%(κ0.45,95%confidenceinterval0.36to0.54).Sixpublished“symptomsandsignsmodels”variedintheirdiscrimination(areaunderreceiveroperatingcharacteristicscurve(ROC)rangedfrom0.55(95%confidenceinterval0.50to0.61)to0.71(0.66to0.7
8、6)).Theoptimalcombinationofclinicalpredictionitemsderivedfromourpatientsincludedabsenceofrunnynoseandpresenceofbreathlessness,cracklesanddiminishedbreathsoundsonauscultation,tachycardia,andfever,withanROCareaof0.70(0.65to0.75).AdditionofCRPattheoptim
