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

doi:10.1136/bmj.38128.631319.AE

BMJ, 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 ¹, Gerben ter Riet ², Patrick J E Bindels ¹, Jacobus H Sloos ³, Henk C P M van Weert ¹

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

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

Design Cohort studyinvolving consecutive patients. Results of index tests and referencestandard were collected independently from each other.

Setting25 Dutch health centres.

Participants 184 adults presenting witha red eye and either (muco)purulent discharge or glued eyelid(s),not wearing contact lenses.

Main outcome measures Probabilityof a positive bacterial culture, given different combinationsof index test results; area under receiver operating characteristicscurve.

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 Abacterial origin of complaints indicative of acute infectiousconjunctivitis can be made much more likely or unlikely by theanswers to three simple questions posed during clinical historytaking (possibly by telephone). These results may have consequencesfor more targeted prescription of ocular antibiotics.

(Accepted 13 May 2004)

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