Assessment of guideline for laboratory use using the method of decision science

应用决策科学的方法制定泌尿系感染（UTI）诊疗中实验室的合理使用指南，将实验室信息系统中的微生物检验数据和医院信息系统中的健康档案数据连接并重建到相关数据库中，以评估临床流行病学调查结果。排尿困难是预测尿路感染的良好指标，并对尿常规和尿沉渣进行ROC分析。同时测定革兰氏染色试验对革兰氏阴性菌和革兰氏阳性菌的敏感性和特异性，并应用决策分析模型，对初始治疗策略与初始试验后根据试验结果选择抗生素的策略进行比较。以90%的革兰氏阴性杆菌为阳性菌的预试概率为判断是否进行尿革兰氏染色筛选抗生素的关键点。在本研究过程中，我们对多中心患者数据库进行了处理，认识到信息系统中编码和项目规范化的重要性。

The guideline for appropriate laboratory use in the care of Urinary Tract Infections(UTI) was made by using the methods of decision science.Laboratory data of microbiological examination in Laboratory information system and health record date in hospital information system were connected and reconstructed to the relational data-base to assess the clinical epidemiologic findings. Dysuria was a good indicator to predict UTI from the symptoms and signs related to urinary tract disorders, and ROC analysis of qualitative urinalysis and urinary sediments were done. The sensitivity and specificity of the gram stain testing for identifying gram negative and gram positive pathogens were also determined.Using a decision analysis model, the strategy of the initial therapy of antibiotics without testing was compared with that of the initial testing and selectiong the antibiotics according to the test results. A 90% of pretest probability of pathogens to be gram negative rods was the critical point to decide to do or not to do urine gram stain for selection of antibiotics.During the course of this study, we processed the multicenter patient database and recognized the importance to standardize the codes and items in the information systems.