预测感染性结膜炎的致病菌:联合症状与体征的队列研究

来源 :世界核心医学期刊文摘.眼科学分册 | 被引量 : 0次 | 上传用户:ljj3061105011
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Objective:To find an efficient set o f diagnostic indicators that are optimally informative in th e diagnosis of a bacterial origin of acute infectious conjunctivitis.Design:Cohort study involving consecutive patien ts.Results of index tests and reference standard were collected independently from each other.Setting:25Dutch health centres.Participants:184adults presenting with a red eye a nd either(muco)purulent discharge or glued eyelid(s),not wearing contact lenses.Main outcome measures:Prob ability of a positive bacterial culture,given different combinations of index test results;area under receiver operating characteristics curv-e.Results:Logistic regression analysis showed optimal diagnostic discrimination for the c ombination of early morn-ing glued eye(s),itch,and a history of conjunctivitis.The first of these indicators increased the likelihood of a bac-terial cause,whereas the other two d ecreased it The area under the receiver operating characteristics curve for this combination of symptoms was 0.74(95%confidence in-terval 0.63to 0.80).The overall prevalence of bacteria l involvement of 32%could be lowered t o 4%or raised to77%,depending on the pattern of index test results.Conclusion:A bacterial origin of co mplaints indicative of acute infectious conjunctivitis can be made much more likely or unlikely by the answers to t hree simple questions posed during clinical history takin g(possibly by tele-phone).These results may have consequences for more targeted prescription of ocular ant ibiotics. Objective: To find an efficient set of diagnostic indicators that are optimally informative in th e diagnosis of a bacterial origin of acute infectious conjunctivitis. Design: Socket study involving consecutive patien ts.Results of index tests and reference standard were collected independently from each other. Setting: 25utch health centers. Participants: 184adults presenting with a red eye a nd either (muco) purulent discharge or glued eyelid (s), not wearing contact lenses. Main outcome measures: Prob ability of a positive bacterial culture, given different combinations of index test results; area under receiver operating characteristics curv-e. Results: Logistic regression analysis showed optimal diagnostic discrimination for the c ombination of early morn-ing glued eye (s), itch, and a history of conjunctivitis. first of these indicators increased the likelihood of a bac-terial cause, and the other two d ecreased it The area under the receiver operating characteristics curve for this combinat The overall prevalence of bacteria l involvement of 32% could be lowered to 4% or raised to 77%, depending on the pattern of index test results. Conclusion: A bacterial origin of co mplaints indicative of acute infectious conjunctivitis can be made much more likely or unlikely by the answers to t hree simple questions posed during clinical history takin g (possibly by tele-phone). These results may have consequences for more targeted prescription of ocular ant ibiotics.
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