Multivariate predictive models for group A beta-hemolytic streptococcal pharyngitis in children
Multivariate predictive models for group A beta-hemolytic streptococcal pharyngitis in children
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DOI：
10.1111/j.1553-2712.1999.tb00087.x
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发表时间：
1999-01-01
影响因子：
4.4
通讯作者：
Meier, F
中科院分区：
文献类型：
--
作者：
Attia, M;Zaoutis, T;Meier, F
目的：建立儿童A组乙型溶血性链球菌（GABHS）咽炎的临床诊断预测模型。方法：6个月至18岁的儿童急诊科疑似GABHS咽炎患者前瞻性纳入研究。临床医生使用标准化表格记录相关临床信息，并使用参考标准方法获得咽拭子培养GABHS。将12例咽培养阳性患者的人口学和临床特征与咽培养阴性患者的特征进行比较。在逐步逻辑回归分析中输入显著不同的特征，以创建诊断的预测模型。结果：85例（29%）GABHS培养阳性，212例（71%）培养阴性。两组患者的平均年龄分别为6.2岁和6.1岁。对12个特征进行单因素卡方分析，确定了6个与GABHS显著相关的变量。所有重要特征最初都包含在逐步逻辑回归分析中。在模型I中，确定了四个独立变量：中度至重度扁桃体肿胀，中度至重度压痛和颈部淋巴结肿大，猩红肿样皮疹的存在，以及中度至重度鼻炎的缺失，产生95%的概率为GABHS。排除罕见的猩红肿样皮疹，其余变量用于第二次回归分析。在模型II中，确定了三个自变量：中度至重度扁桃体肿胀，中度至重度压痛和颈部淋巴结肿大，以及缺乏中度至重度鼻炎，诊断概率为65%。概率是65%。相反，在没有中度至重度扁桃体肿胀、宫颈结肿大和鼻炎的情况下，喉部培养阳性的概率为
Objectives: To create predictive models for the clinical diagnosis of group A beta-hemolytic streptococcal (GABHS) pharyngitis in children. Methods: Patients aged 6 months to 18 years presenting to a pediatric ED with suspected GABHS pharyngitis were prospectively enrolled in the study. Clinicians recorded pertinent clinical information using a standardized form and obtained a throat swab to culture GABHS using a reference standard method. Twelve demographic and clinical features of patients with positive throat cultures were compared with the features of patients with negative throat cultures. Significantly different features were entered in a stepwise logistic regression analysis to create predictive models for the diagnosis. Results: Eighty-five patients (29%) were culture-positive and 212 (71%) were culture-negative for GABHS. Respective mean ages were 6.2 years and 6.1 years in the two groups. Univariate chi-square analysis of the 12 features identified six variables that were significantly associated with GABHS. All significant features were initially included in a stepwise logistic regression analysis. In model I, four independent variables were identified: moderate to severe presentation of tonsillar swelling, moderate to severe tenderness and enlargement of cervical lymph nodes, the presence of scarlatiniform rash, and the absence of moderate to severe coryza, yielding a 95% probability for GABHS. Excluding the rare scarlatiniform rash, the remaining variables were used in the second regression analysis. In model II, three independent variables were identified: moderate to severe tonsillar swelling, moderate to severe tenderness and enlargement of cervical lymph nodes, and absence of moderate to severe coryza, yielding a probability of 65% for the diagnosis. A probability of 65%. Conversely, in the absence of a moderate to severe presentation of tonsillar swelling, enlargement of cervical nodes, and the presence of coryza, the probability of a positive throat culture is