Eficácia do exame clínico para o diagnóstico de anemia na criança pela palidez palmar e dosagem de hemoglobina / Efficacy of the clinical examination for the diagnostic of anemia in children by palmar pallor and hemoglobin samples

RESUMO

Objetivo: Avaliar a eficácia e a concordância do diagnóstico clínico de anemia pelo exame da palidez palmar comparado com valores de hemoglobina capilar. Método: Estudo de corte transversal em crianças matriculadas nas creches públicas de Natividade (RJ), no quarto bimestre de 2006. O exame clínico foi efetuado por dois examinadores treinados nas normas AIDPI (Atenção Integrada às Doenças Prevalentes na Infância). A dosagem da hemoglobina foi realizada por um fotômetro e especificidade foram baixos entre os dois examinadores e a concordância pelo coeficiente Kappa variou de 0,12 a 20. A concordância entre os dois métodos foi pior entre as crianças menores de dois anos de idade e com anemia moderada-grave. Conclusão: Os resultados baixos da sensibilidade e especificidade, assim como da concordância entre os examinadores no diagnóstico clínico de anemia, ressaltam a importância de uma reavaliação deste método no atual contexto dessa carência nutricional no país...

ABSTRACT

Objective: To evaluate the validity and agreement of the diagnosis of anemia through Palmar Pallor clinical examination carried out by two examiners trained within the norms of the IMCI (Integrated Management of Childhood Illnesses), with the diagnostic of anemia through the sample of hemoglobin taken from children in public day-care centers. Methods: A study of transversal cut was carried out, in children enrolled in public day-care centers in Natividade (Rio de Janeiro), in the fourth bimester of 2006. The clinical exam of Palmar Pallor performed by two examiners trained within the norms of IMIC and a sample of hemoglobin through a portable photometer (HemoCue®) and used the criteria of the OMS for its classification and gravity. The values were calculated for sensitivity and specification in the clinical examination and the value of Kappa coefficient for the agreement between the two examiners. Results: Three hundred and sixteen (316) children were evaluated, the mean age was 45.3 months (6 to 108 months), 52% were male children and 47.3% were female. The prevalence of anemia from the hemoglobin sample was 43.7% greater in the children younger than 12 months (85.6%) and among 12 to 24 months (66%). Anemia for the clinical method varied of 42.3% to 66.5%. The values of sensitivity and specificity were low among the two examiners and the agreement through Kappa coefficient varied from 0.12 to 20. The agreement between the two methods was worse among the children younger than 2 years of age and with moderate to acute anemia. Conclusion: The low results of sensitivity and specificity, as well as the agreement between the two examiners in the clinical diagnostic of anemia, allows us to pronounce the importance of a re-evaluation of this method in the current context of a lack in the nutritional quality in this country...