Commentary on da Silva VM, de Oliviera Lopes MV, de Araujo TL, Ciol MA, de Carvahlo EC (2009) Clinical indicators of ineffective airway clearance in children with congenital heart disease. Journal of Clinical Nursing 18, 729-736.

摘要

The problem with trying to develop lists of clinical indicators is that everyone has to have their say. Therefore, far from becoming definitive, meaningful lists with any utility in clinical practice, such lists - sometimes formulated as checklists or inventories - become a reflection of those who compiled them rather than a reflection of what is wrong with the patients in whom diagnosis may mean the difference between life and death. Thus, the present paper by da Silva et al. (2008) is a valuable contribution, not only to the literature on childhood cardiology in particular, but also to the nursing and medical diagnostics in general. On reading papers like this one I am left with the opinion that if only a committee had not been called to do this in the first place but that a lone researcher, or small team, had been 'let loose' with the symptoms and meticulously checked each one for sensitivity and specificity then progress would have been made long ago. Such is the benefit of hindsight, but it does appear - from this study at least - that the majority, in fact, of the putative symptoms are useless with respect to actual diagnosis of ineffective airway clearance in children with congenital heart disease.