评价《中国儿童慢性咳嗽诊断与治疗指南(2013版)》的临床应用符合度

Evaluating Clinical Application Compliance of 2013 Guideline for the Diagnosis and Treatment of Chronic Cough in Chinese Children

摘要: 目的：评价《中国儿童慢性咳嗽诊断与治疗指南(2013版)》的临床实践符合度。方法：本研究包括两部分：第一部分是用层次分析法(analytic hierarchy process, AHP)建立一个2级层次结构的指南评价模型，用一致性通过的101份专家问卷计算各评价指标的权重。第二部分是基于临床病例的回顾性研究，结合指南评价模型对指南临床符合度进行评价，并分析影响符合度的主要因素，为指南的更新修订提供依据。结果：本研究共回收有效专家问卷307份，根据AHP基本原理用一致性检验通过的101份专家问卷计算评价指标的权重并建立临床评价模型。基于临床病例的符合度判断中，共纳入的407份病例的总体符合度(81.34 ± 11.39)%，其中干性咳嗽的总体符合度为(81.35 ± 11.84)%，湿性咳嗽的总体符合度为(80.86 ± 11.37)%，两者无统计学差异(P > 0.05)。对于二级指标，符合度最高的为“病史询问”，最低的为“辅助检查”。结论：本研究结合临床病例和专家问卷，评估了《中国儿童慢性咳嗽诊断与治疗指南(2013版)》与临床实践的一致性，并分析了影响该指南在儿科临床应用中的因素，为指南的修订和更新提供线索。

Abstract: Objective: To evaluate clinical application of the 2013 Guideline for the Diagnosis and Treatment of Chronic Cough in Chinese Children. Method: This study was divided into two parts. The first part was to establish guideline evaluation model by building a 2-level Analytic Hierarchy Process (AHP) construction. The weights were calculated based on 101 questionnaires that passed consistency test. The second part was to perform a retrospective study. The study analyzed the clinical implementation of the guideline-based on clinical cases. Finally, suggestions about updating guideline were provided based on the results of the expert questionnaire and clinical cases. Results: A total of valid 307 questionnaires were collected, the weights of indexes were calculated based on the 101 questionnaires that passed the consistency test and evaluation model was established. 407 clinical cases were included to evaluate the clinical implementation and consistency of the guideline, the overall consistency of 407 clinical cases was (81.34 ± 11.39)%. The overall consistency in dry cough was (81.35 ± 11.84)%, with no statistical difference (P > 0.05) compared with that in wet cough (80.86 ± 11.37)%. For the second-level indexes, the highest consistency is “medical history”, and the lowest consistency is “auxiliary examination”. Conclusion: This study evaluated consistency between 2013 Guideline for the Diagnosis and Treatment of Chronic Cough in Chinese Children and clinical practice based on clinical cases and expert questionnaire. It also uncovered the indexes affecting application of the guideline in pediatricians, which may provide clues to improve and update the guideline.