The Duke criteria for diagnosing infective endocarditis are specific: Analysis of 100 patients with acute fever or fever of unknown origin
The Duke criteria for diagnosing infective endocarditis are specific: Analysis of 100 patients with acute fever or fever of unknown origin
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DOI：
10.1093/clinids/23.2.298
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发表时间：
1996-08-01
影响因子：
11.8
通讯作者：
Canton, P
中科院分区：
文献类型：
--
作者：
Hoen, B;Beguinot, I;Canton, P
最近提出的Duke标准被证实比以前的Beth Israel诊断感染性心内膜炎（IE）的标准更敏感。为了评估Duke标准的特异性，我们回顾了两个内科病房因急性发热或不明原因发热（FUO）而入院的100例患者的记录，IE被认为是所有至少进行过两次血培养和一次经胸超声心动图检查的患者的可能诊断。所有病例均根据Duke标准（即明确的替代诊断[n = 23]，症状得到缓解但未使用抗生素[n = 39]，或两者皆有[n = 38]）拒绝诊断IE。为了计算Duke标准的特异性，所有100例病例根据这些标准重新分类，就好像IE的诊断没有被拒绝一样，只有1例患者可能没有IE，被重新分类为临床明确的IE。因此，杜克标准的特异性可以计算为0.99（95%可信区间为0.97-1）。虽然该研究的设计可能导致对特异性率的略微高估，但我们得出结论，杜克标准对于排除急性发烧或FUO患者的IE具有高度特异性，这些患者的IE风险较低。
The recently proposed Duke criteria were confirmed to be more sensitive than the former Beth Israel criteria for the diagnosis of infective endocarditis (IE), To assess the specificity of the Duke criteria, we reviewed the records of 100 patients admitted to two internal medicine wards because of acute fever or fever of unknown origin (FUO), IE was considered a possible diagnosis for all patients who had had at least two blood cultures performed and one transthoracic echocardiogram obtained. The diagnosis of IE was rejected in ail cases in accordance with the Duke criteria (i.e., a firm alternate diagnosis [n = 23], resolution of symptoms with no antibiotics [n = 39], or both reasons [n = 38]). To calculate the specificity of the Duke criteria, all 100 cases were then reclassified according to these criteria as if the diagnosis of IE had not been rejected, Only one patient, who probably did not have IE, was reclassified as having clinically definite IE. The specificity of the Duke criteria could therefore be calculated to 0.99 (95% confidence interval, 0.97-1). Although the design of the study may have resulted in a slight overestimation of the specificity rate, we conclude that the Duke criteria are highly specific for ruling out IE in patients with acute fever or FUO who are at low risk for IE.