Evaluating the Diagnostic Paradigm for Group A and Non-Group A Streptococcal Pharyngitis in the College Student Population.
Evaluating the Diagnostic Paradigm for Group A and Non-Group A Streptococcal Pharyngitis in the College Student Population.
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DOI：
10.1093/ofid/ofab482
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发表时间：
2021-11
影响因子：
4.2
通讯作者：
Turley MK
中科院分区：
文献类型：
--
作者：
Rich SN;Prosperi M;Klann EM;Codreanu PT;Cook RL;Turley MK
急性咽炎是一种常见的疾病，出现在门诊设置。抗生素仅推荐用于由A组β-溶血性链球菌（GAS）引起的细菌性咽炎;然而，非A组β-溶血性链球菌（NGAS）感染具有相似的临床表现，在年轻成人人群中很常见。本研究的目的是分析当前（专家）诊断算法GAS咽炎的性能，Centor评分，并将其与开发用于预测大学生人群中GAS和NGAS的替代模型进行比较。2014年在美国东南部一所大学获得了所有接受链球菌快速抗原检测试验（RADT）和/或细菌咽喉培养的患者（n =3963）的电子健康记录。 拟合双变量和多变量回归模型（最小绝对收缩和选择算子[LASSO]和逐步选择），以评估和比较其对GAS阳性和NGAS阳性感染的诊断性能。GAS患病率为18.8%。在接受细菌咽喉培养的RADT阴性患者亚组（n = 313）中，NGAS生长发生在34.8%，C组链球菌是最常见的分离株。 NGAS感染的平均Centor评分（3.2）高于GAS感染（2.9）（P = 0.0111）。 GAS预测的曲线下面积（AUC）使用Centor评分为0.64，使用LASSO模型为0.70。对于NGAS，最重要的特征是咳嗽、咽部红斑、扁桃体渗出物和胃肠道症状（AUC = 0.63）。在这项研究中，GAS和NGAS咽炎在大学生中是无法区分的，采用了常用的决策评分。使用其他临床标准的替代模型可能有助于支持这种常见疾病的诊断。在这项研究中，A组和非A组链球菌性咽炎感染是无法区分的大学生利用一个常用的决策评分。使用其他临床标准的替代模型可能有助于支持这种常见疾病的诊断。
Acute pharyngitis is a frequent illness presenting in outpatient settings. Antibiotics are only recommended for bacterial pharyngitis caused by group A β-hemolytic streptococci (GAS); however, infections with non–group A β-hemolytic streptococci (NGAS) have similar clinical presentations and are common in young adult populations. The objective of this study was to analyze the performance of a current (expert) diagnostic algorithm for GAS pharyngitis, the Centor score, and compare it to alternative models developed to predict GAS and NGAS in a college student population. Electronic health records were obtained for all patients who received a streptococcal rapid antigen detection test (RADT) and/or a bacterial throat culture (n = 3963) at a southeastern US university in 2014. Bivariate and multivariable regression models (least absolute shrinkage and selection operator [LASSO] and stepwise-selected) were fitted to assess and compare their diagnostic performances for GAS-positive and NGAS-positive infections. Prevalence of GAS was 18.8%. In the subset of RADT-negative patients who received bacterial throat cultures (n = 313), growth of NGAS occurred in 34.8%, with group C streptococci the most frequent isolate. Mean Centor score was higher for NGAS (3.2) vs GAS (2.9) infections (P = .0111). The area under the curve (AUC) for GAS prediction was 0.64 using the Centor score and 0.70 using the LASSO model. For NGAS, the most important features were cough, pharyngeal erythema, tonsillar exudate, and gastrointestinal symptoms (AUC = 0.63). GAS and NGAS pharyngitis were indistinguishable among college students in this study utilizing a commonly applied decision score. Alternative models using additional clinical criteria may be useful for supporting diagnosis of this common illness. Group A and non–group A streptococcal pharyngitis infections were indistinguishable among college students in this study utilizing a commonly applied decision score. Alternative models using additional clinical criteria may be useful for supporting diagnosis of this common illness.
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影响因子：
39.2
作者：
Centor, Robert M.;Atkinson, Prescott;Waites, Ken B.
通讯作者：
Waites, Ken B.
影响因子：
1.5
作者：
Chandnani, Harsha K.;Jain, Renu;Patamasucon, Pisespong
通讯作者：
Patamasucon, Pisespong
影响因子：
11.8
作者：
Bisno, AL;Gerber, MA;Schwartz, RH
通讯作者：
Schwartz, RH
影响因子：
120.7
作者：
TURNER, JC;HAYDEN, GF;MURREN, D
通讯作者：
MURREN, D
DOI：
10.1177/0272989x8100100304
发表时间：
1981-01-01
期刊：
Medical decision making : an international journal of the Society for Medical Decision Making
影响因子：
--
作者：
Centor, R M;Witherspoon, J M;Link, K
通讯作者：
Link, K