A Quantitative Study of the Decision Threshold for the Diagnosis of Infectious Mononucleosis

Journal of the American Board of Family Medicine: JABFM

article

Xinyan Cai¹  Mark H. Ebell¹  Garth Russo² 

[1] Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia;University of Georgia Health Science Center

关键词: Clinical Prediction Rule;    Evidence-Based Medicine;    Infectious Mononucleosis;    Logistic Models;    Pharyngitis;    Primary Health Care;    Routine Diagnostic Tests;   

DOI  :  10.3122/jabfm.2022.210185R1

学科分类：过敏症与临床免疫学

来源: The American Board of Family Medicine

【 摘 要 】

Background: Ordering a serologic test for infectious mononucleosis (IM) in all young patients with sore throat is costly and impractical. The test threshold to determine when to order a diagnostic test for IM based on the patient’s symptoms has not been previously studied.Objective: To determine the test threshold for IM in the management of patients with sore throat.Design and Setting: Online surveys were sent to a convenience sample of US primary care clinicians regarding their decision making about whether or not to order a test for IM in a patient with sore throat.Method: 7 clinical vignettes were created, each with a different combinations of symptoms and signs. The probability of IM for each vignette was estimated by the investigator based on the number of symptoms present to generate a plausible range of disease probabilities. Clinicians were then asked to decide whether to test or not test for IM, and mixed-effect logistic regression was used to determine the test threshold for IM where half of physicians chose to test and half chose not to test.Results: A total of 117 clinicians provided responses for a total of 819 clinical vignettes. The overall test threshold for IM as estimated using the logistic regression was 9.5% (95% CI: 8.2% to 10.9%). The test threshold for clinicians practicing greater than 10 years was significantly higher than for those practicing less or equal to 10 years (10.5% vs 7.3%, P = .02). No significant differences between specialties and practice sites were found with respect to the test threshold.Conclusion: This study identified a test threshold for IM of approximately 10% based on realistic clinical vignettes. This threshold was stable regarding the clinician’s specialty and practice sites and could be used in the development of a clinical prediction rule to determine the cutoff for low- versus high-risk groups.

【 授权许可】

CC BY