Predicting bacterial cause in infectious conjunctivitis: cohort study on informativeness of combinations of signs and symptoms

doi:10.1136/bmj.38128.631319.AE

BMJ 2004;329:206-210 (24 July), doi:10.1136/bmj.38128.631319.AE (published 16 June 2004)

Primary care

Predicting bacterial cause in infectious conjunctivitis: cohort study on informativeness of combinations of signs and symptoms

Remco P Rietveld, general practitioner¹, Gerben ter Riet, epidemiologist², Patrick J E Bindels, professor in general practice¹, Jacobus H Sloos, consultant microbiologist³, Henk C P M van Weert, general practitioner¹

¹ Division of Clinical Methods and Public Health, Department of General Practice, Academic Medical Centre, University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, Netherlands, ² Horten-Zentrum, Zurich, Switzerland, ³ Medical Centre Alkmaar, Alkmaar, Netherlands

Correspondence to: R P Rietveld r.p.rietveld{at}amc.uva.nl

Objective To find an efficient set of diagnostic indicatorsthat are optimally informative in the diagnosis of a bacterialorigin of acute infectious conjunctivitis.

Design Cohort study involving consecutive patients. Resultsof index tests and reference standard were collected independentlyfrom each other.

Setting 25 Dutch health centres.

Participants 184 adults presenting with a red eye and either(muco)purulent discharge or glued eyelid(s), not wearing contactlenses.

Main outcome measures Probability of a positive bacterial culture,given different combinations of index test results; area underreceiver operating characteristics curve.

Results Logistic regression analysis showed optimal diagnosticdiscrimination for the combination of early morning glued eye(s),itch, and a history of conjunctivitis. The first of these indicatorsincreased the likelihood of a bacterial cause, whereas the othertwo decreased it. The area under the receiver operating characteristicscurve for this combination of symptoms was 0.74 (95% confidenceinterval 0.63 to 0.80). The overall prevalence of bacterialinvolvement of 32% could be lowered to 4% or raised to 77%,depending on the pattern of index test results.

Conclusion A bacterial origin of complaints indicative of acuteinfectious conjunctivitis can be made much more likely or unlikelyby the answers to three simple questions posed during clinicalhistory taking (possibly by telephone). These results may haveconsequences for more targeted prescription of ocular antibiotics.

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