Predicting Clostridium difficile stool cytotoxin results in hospitalized patients with diarrhea.
Predicting Clostridium difficile stool cytotoxin results in hospitalized patients with diarrhea.
复制标题
预测住院腹泻患者的艰难梭菌粪便细胞毒素结果。
DOI：
10.1046/j.1525-1497.1997.12108.x
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发表时间：
1997
影响因子：
5.7
通讯作者：
Snydman,D
中科院分区：
文献类型：
--
作者：
Katz,DA;Bates,DW;Rittenberg,E;Onderdonk,A;Sands,K;Barefoot,LA;Snydman,D
目的验证艰难梭菌细胞毒素检测结果的预测模型，并确定常规细胞毒素检测产量低的极低可能性艰难梭菌相关疾病患者亚组。前瞻性队列研究。在报告检测结果之前，记录相关临床症状、体征和抗生素暴露情况。每个预测因子根据回归系数进行评分，并根据总分对患者进行分层。两个城市三级医疗大学医院。PATIENTSA在1994年3个月期间接受艰难梭菌细胞毒素检测的609名连续住院成人患者。测量和主要结果细胞毒素检测的阳性率在验证集为8%，而在推导集为14%。将既往未使用抗生素且至少有一种症状预测因子（明显腹泻或腹痛）的患者定义为低风险亚组，检测结果的错误分类率为2.8% (5/177)；在5例误分类病例中，只有1例被判定患有艰难梭菌相关疾病。使用这一规则来识别低风险患者可以潜在地避免29%的所有细胞毒素检测。结论接触特定临床领域的榜样与医学生选择住院医师培训的临床领域密切相关。了解学生在他们的榜样中寻找哪些特征，应该有助于确定可能对医学生的职业选择最有影响的医生。
OBJECTIVETo validate a model for the prediction of Clostridium difficile cytotoxin assay results, and to identify a subgroup of patients with a very low likelihood of C. difficile-associated disease in whom the yield of routine cytotoxin testing is low.DESIGNProspective cohort study. Relevant clinical symptoms, signs, and antibiotic exposure were recorded before reporting of assay results. Each predictor was assigned a score based on regression coefficients, and patients were stratified according to their total score.SETTINGTwo urban, tertiary care, university hospitals.PATIENTSA total of 609 consecutive adult inpatients who received testing for C. difficile cytotoxin during a 3-month period in 1994.MEASUREMENTS AND MAIN RESULTSThe prevalence of positive cytotoxin assays was 8% in the validation set, compared with 14% in the derivation set. Defining patients without both prior antibiotic use and at least one symptom predictor (significant diarrhea or abdominal pain) as a low-risk subgroup, the misclassification rate was 2.8% (5/177) for assay results; of the five misclassified cases patients, only one was judged to have C. difficile-associated disease. Use of this rule to identify low-risk patients could have potentially averted 29% of all cytotoxin assays.CONCLUSIONSExposure to role models in a particular clinical field is strongly associated with medical students' choice of clinical field for residency training. Knowing which characteristics students look for in their role models should help identify the physicians who may be most influential in medical students' career choice.