| Objective:The clinical epidemiological characteristics of children with pertussis were described and a clinical prediction model for pertussis diagnosis was established,which provided a reference for strengthening sentinel surveillance in pertussis medical institutions and the formulation of prevention and treatment strategies by public health administrative departments,and also put forward new ideas for timely and efficient clinical diagnosis of pertussis.Methods:1.Using the case series analysis in the descriptive study,631 children with pertussis diagnosed in Shanxi Children’s Hospital(Shanxi Provincial Maternal and Child Health Hospital)from 2021.9～2022.10 were included as the research object,designing an information collection table,collecting baseline information and relevant clinical data of children with pertussis and describe their clinical epidemiological characteristics.2.Using the current situation study in the descriptive study,randomly including 300 children who met the inclusion exclusion criteria from 2021.9～2022.10 as the study object,designing an information collection table,collecting baseline information and relevant clinical data of the children,dividing into pertussis group and non-pertussis group according to laboratory diagnosis,describing its characteristics and constructing a pertussis clinical prediction model.3.Excel for data information entry,SPSS22.0 and R for data cleaning and data analysis.The number of use cases(%)of counting data is denoted,the measurement datais expressed by ` x ± s,and the t-test,c 2 test,and ANOVA are used for comparison between groups;Multivariate analysis adopts unconditional logistic regression analysis,and draws nomograms,internal verification by bootstrap self-sampling method,calculation of consistency index(C-index),calibration curve,subject operating characteristic curve(ROC)and clinical decision curve.The test level α = 0.05,P < 0.05 was considered to be statistically significant.Results:1.Clinical features of children with pertussis1.1 GeneralBetween October 2021~September 2022,a total of 1013 children underwent laboratory tests for pertussis,and 631 cases(62.30%)of pertussis were confirmed,and382 cases(37.70%)of non-pertussis were confirmed.Among them,11 cases were positive for bacterial culture,490 cases were positive for nucleic acid detection,and 252 cases were positive for Ig M.Among the 631 hospitalized children with whooping cough,more males(52.00%)than females(48.00%);51.03% were < 1-years-old;The top four in regional distribution were Taiyuan,Lüliang,Xinzhou and Jinzhong,accounting for 83.70%;The largest number of children were in summer,with a total of 239 cases(37.90%);57.85% were vaccinated according to the procedure;Before admission,a small number of children(21.10%)had fever,a very small number(1.90%)had no drug history,and 91.40% had used antibiotics.1.2 Clinical symptoms of children with pertussisParoxysmal cough(71.30%),flushing complexion(42.80%),vomiting after cough(30.40%),nocturnal cough(59.40%),paroxysmal sputum cough(38.20%),paroxysmal spastic cough(38.5%)had a higher proportion,and the proportion of other symptoms was less,less than 30%.The vast majority of children(98.70%)were conscious when admission,and only 8 cases were accompanied by consciousness disorders.Only 22cases were normal on lung auscultation,and crackles(25.00%)and sputum sounds(41.00%)were heard in the majority.1.3 Auxiliary examination results of children with pertussisThe absolute value of LYM(86.69%),PLT(83.84%),PCT(81.77%),LDH(77.02%),and WBC count(69.57%)were abnormal.The absolute value of NE(31.85%)and CRP(31.38%)abnormalities accounted for a low proportion.54.04% of the children underwent immunoglobulin testing,and 67.74% of the children had abnormal immunoglobulin.43.74% of the children were tested for lymphocyte subsets,and91.30% of the children had abnormal lymphocyte subsets.20.29% of the children had fever during hospitalization,and the heat course was 1.88±1.87 days.1.4 Treatment of children with pertussisAntibiotics were used in the treatment,and macrolides(92.10%)and β-lactam(72.60%)had a high proportion of antibiotics.97.50% of children were atomized;308(48.80%)of the children needed to be given oxygen,337(53.40%)needed sputum,and the proportion of other therapeutic drugs or measures was not high,less than 30.00%.1.5 Complications and outcomes of children with pertussisThe most common complications were pneumonia,accounting for 88.40%,and the remaining complications such as respiratory failure(1.40%)and toxic encephalopathy(0.20%)were less.92.20% of the children still needed to continue taking medication when they were discharged,78.10% were cured,and only 1 case was not cured.1.6 Comparison of clinical features of children with pertussis of different sexesThe clinical features of children with pertussis did not differ much between sexes,mainly because the proportion of reddening complexion and vomiting after coughing was higher in the female group than in the male group(47.19% > 38.72%;35.31% > 25.91%),the proportion of sulfonamide antibiotics in the female group was lower than that in the male group(11.22% < 17.99%),the proportion of traditional Chinese medicine was higher than that in the male group(17.82% > 10.06%),and the proportion of cured in the female group was higher than that in the male group(81.85% > 74.70%).There were no significant differences in the remaining features between the male and female groups(P > 0.05).1.7 Comparison of clinical features of children with pertussis of different agesThe main characteristics of the four groups were that the younger the age,the shorter the number of cough days before admission(15.03 ± 9.55,18.82 ± 12.51,21.89 ±17.62,21.92 ± 13.81),the disease was more severe and the course of the disease was longer,such as WBC count(15.96 ± 7.75,19.90 ± 10.36,12.83 ± 17.62,10.74 ± 5.24),and LYM(12.31 ± 13.83,14.61 ± 8.74,7.49 ± 7.00,4.43 ± 2.85),hospitalization days(11.05 ± 4.76,10.29 ± 6.04,8.52 ± 3.42,8.06 ± 3.19)the children in the younger age group were higher.In addition,the proportion of children in the four groups with allergy history,bleeding history,fever ratio,fever days,proportion of antibiotic use before admission,number of days of medication,paroxysmal bruising,flushing of the complexion,runny nose,paroxysmal sputum cough,spit,normal lung auscultation,sputum sound,blister sound,auxiliary examination of absolute NE value,PLT count,LDH,treatment of β-lactams,sulfonamides,traditional Chinese medicine,oxygen,sputum suction,complications pneumonia,heart disease,anemia,rhinitis,The difference in proportion of asthma was statistically significant(P < 0.05),but the difference was not clinically significant,and the remaining features were not statistically significant between the four groups(P > 0.05).1.8 Comparison of clinical features of children with pertussis with different immune statusThe main characteristics of the three groups were the shortest number of cough days before admission in the under-vaccinated age group(12.89 ± 8.17),followed by the unvaccinated group(17.22 ± 11.80),the longest vaccination group according to the procedure(21.16 ± 15.17),and the longest number of hospitalization days in the under-vaccination age group(12.01 ± 5.07),followed by the unvaccinated group(10.14± 4.79),and the shortest vaccination group according to the procedure(8.75 ± 3.88),Of the three groups,the rate of cure was highest in the routine vaccination group(82.74%).In addition,the proportion of allergy history,flow history,fever,proportion of antibiotics and cough drugs used before admission,number of days of medication,paroxysmalbruising,runny nose,cough at night,spitting in clinical symptoms and signs,proportion of crackles,phlegm sounds,and blister sounds on lung auscultation,laboratory WBC count,absolute NE value,absolute LYM value,PLT count,PCT,LDH,proportion of antibiotics macrolides and sulfonamides,proportion of traditional Chinese medicine,oxygen and suction,The proportion of complications heart disease,anemia,rhinitis,asthma were statistically significant(P < 0.05),but the difference was not clinically significant,and the difference in the remaining features was not statistically significant between the three groups(P > 0.05).2.Study on clinical prediction model of pertussis2.1 The characteristics of the two groups were comparedAmong the 300 children included in the study,187 were diagnosed with pertussis,including 3 positive bacterial cultures,138 positive nucleic acids,and 62 Ig M positive cases.There were 113 cases of non-pertussis.The proportion of vaccinated according to the procedure in the case group was lower than that in the control group(55.08% < 81.42%).The number of days of cough before admission was longer in the case group than in the control group(9.93 ± 4.91 >8.38 ± 5.06),and the proportion of fever before admission in the case group was lower than that in the control group(20.32% < 45.13%),the proportion of chicken echo,flushed complexion,vomiting after coughing,nocturnal cough,and paroxysmal spastic cough in the case group was higher than that in the control group(7.49% > 1.77%;40.64% > 13.27%;28.88% > 9.73%;58.29% > 34.51%;32.62% > 7.96%),and the proportion of other symptoms of sputum cough,three-pitting sign,wheezing,nasal congestion and spitting was lower than that of the control group(42.25% < 59.29%;2.14% < 16.81%;6.95% < 32.74%;6.95% < 15.04%;2.67% < 8.85%);The proportion of normal lung auscultation and crackles and stridor in the case group was lower than that in the control group(0.00% < 24.78%;24.60% < 41.59%;8.02% < 36.28%)。The WBC count,LYM and PLT count in the case group were higher than those in the control group(13.92 ± 7.24 > 10.96 ± 4.87;10.09 ± 16.63 > 6.23 ± 6.59;446.00 ±154.00 > 391.00 ± 140.00),NE was lower in the case group than in the control group(3.85 ± 2.65 < 5.01 ± 5.15).Macrolide antibiotics(91.98%)were mainly used in the case group,β-lactam antibiotics(83.19%)were mainly used in the control group,and the proportion of traditional Chinese medicine and sputum suction in the case group was lower than that in the control group(11.23% < 28.32%;55.61% < 77.88%).The number of days hospitalized in the case group was longer than that in the control group(9.98 ± 4.86 >8.23 ± 4.77),and the proportion of cured cases in the case group was lower than that in the control group(73.26% < 94.69%)。2.2 Multivariate logistic analysisMultivariate logistic results showed that pertussis vaccine(OR=0.022,95%CI:0.001-0.875),positive tridentation sign(OR=0.002,95%CI: 0.000-0.112),crackles(OR=0.010,95%CI: 0.024-0.596),stridor(OR=0.041,95%CI: 0.004-0.429),anemia(OR= 0.006,95%CI: 0.000-0.343)was inversely associated with pertussis,and platelet count was not associated with pertussis(OR=1.007,95%CI: 1.000-1.014).2.3 Column diagram model constructionA predictive model was constructed based on the results of multivariate logistic,showing that the probability of diagnosis of pertussis in the presence of the above factors was 0.25.In order to ensure the versatility of the model,the ROC curve showed that the AUC was 79.60%,the sensitivity was 83.20%,and the specificity was 65.20%,indicating that the model had high efficiency in predicting the occurrence of pertussis.The calibration curve shows that the correction curve is similar to the ideal curve,and the calibration curve shows that the actual prediction curve of the model is in good agreement with the modified prediction curve,Brier=0.177,C-index is 0.796;the decision curve shows that with the increase of threshold probability,the net return of the model will decrease,and the threshold probability of the model ranges from 2% to 90%,and almost all threshold probabilities have obvious net benefits.Conclusions:1.The proportion of whooping cough among the surveillance targets was as high as62.33%,suggesting that medical institutions and public health administrative departments should strengthen the monitoring of pertussis,grasp its epidemic characteristics,and then formulate more complete pertussis prevention and treatment strategies.2.< 1-year-old infants and young children account for a relatively large proportion of pertussis cases,and because of its special physiological stage,low immunity,more severe disease,longer course of disease,it is recommended that relevant departments can improve pertussis immunization strategy,vaccination of pertussis vaccine during pregnancy to protect newborns who cannot complete primary immunization,and also take measures to improve pertussis vaccine coverage,so as to achieve herd immunity.3.The proportion of typical clinical symptoms of pertussis patients is small,resulting in the early stage of infection can not be diagnosed in time,and delay treatment,it is recommended that medical institutions strengthen training,improve clinicians’ ability to identify pertussis,and rationally use laboratory tests to make timely and correct diagnosis. |
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