背景:分类不明原因发热(FUO)患者的标准仍然存在差异。一套最低限度的标准化调查测试作为定性标准的基础,而定量包括评估的长度(7或3天)。对研究的系统回顾将有助于医生预测可能影响管理的疾病类型的频率。
方法:发表在Medline(PubMed)上的前瞻性研究,Embase,Scopus,和WebofScience数据库从1997年1月1日到2022年7月31日被包括在内。根据国际疾病分类,对这些标准和诊断结果之间的相关汇总比例进行了荟萃分析,第10版(ICD-10)定义。
结果:五项定性研究增加了15.3%(95%CI:2.3-28.3%,p=0.021)与11项定量研究相比,未诊断的FUO比例。定量研究为19.7%(95%CI:6.0-33.4%,p=0.005)调整后的传染病比例高于定性研究。FUO定义标准之间的比例没有显着差异,注意到调整的非感染性炎症性疾病(p=0.318),肿瘤学(p=0.901),非炎性杂病(p=0.321),诊断评估过程,国民总收入(GNI),或世界卫生组织(WHO)地理区域。
结论:当使用ICD-10调整的FUO五类系统时,使用定性或定量FUO标准与过度估计或低估传染病和未诊断疾病的统计学显著风险相关。临床医生应根据使用的标准预测差异。虽然需要进一步的研究,定性标准为研究比较提供了最佳框架.
BACKGROUND: Criteria classifying fever of unknown origin (FUO) patients remains subject to discrepancies. A minimal standardized set of investigative tests serves as the foundation for the qualitative criteria, whereas quantitative incorporates the length of evaluation (7 or 3 days). A systematic review of studies would help physicians anticipate the frequency of illness types that could influence management.
METHODS: Prospective studies published in Medline (PubMed), Embase, Scopus, and Web of Science databases from January 1, 1997, to July 31, 2022, were included. A meta-analysis estimated associated pooled proportions between these criteria and diagnostic outcomes adjusted to the International Classification of Diseases, 10th edition (ICD-10) definitions.
RESULTS: Five qualitative studies corresponded to an increase of 15.3% (95% CI: 2.3-28.3%, p=0.021) in undiagnosed FUO proportions compared to eleven quantitative studies. Quantitative studies had 19.7% (95% CI: 6.0-33.4%, p=0.005) more in adjusted infectious disease proportions than qualitative studies. No significant differences in proportions between FUO defining criteria were noted for adjusted noninfectious inflammatory disorders (p=0.318), oncology (p=0.901), non-inflammatory miscellaneous disorders (p=0.321), diagnostic evaluation process, gross national income (GNI), or World Health Organization (WHO) geographic region.
CONCLUSIONS: Use of either qualitative or quantitative FUO criteria was associated with a statistically significant risk of over- or under-estimating infectious diseases and undiagnosed illnesses when using an ICD-10 adjusted FUO five-category system. Clinicians should anticipate differences depending on which criteria are used. While further research is warranted, qualitative criteria provide the best framework for study comparisons.