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

Humans Infectious Mononucleosis / diagnosis Pharyngitis / diagnosis Serologic Tests / methods Physicians Probability
Clinical Prediction Rule Evidence-Based Medicine Infectious Mononucleosis Logistic Models Pharyngitis Primary Health Care Routine Diagnostic Tests

Journal

Journal of the American Board of Family Medicine : JABFM
ISSN: 1558-7118
Titre abrégé: J Am Board Fam Med
Pays: United States
ID NLM: 101256526

Informations de publication

Date de publication:
23 12 2022
Historique:
received: 29 04 2021
revised: 14 07 2022
accepted: 26 07 2022
pubmed: 17 12 2022
medline: 28 12 2022
entrez: 16 12 2022
Statut: ppublish

Résumé

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. To determine the test threshold for IM in the management of patients with sore throat. 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. 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. 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%, 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.

Sections du résumé

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%,
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.

Identifiants

DOI: 10.3122/jabfm.2022.210185R1 PMID: 36526329
pubmed: 36526329
pii: jabfm.2022.210185R1
doi: 10.3122/jabfm.2022.210185R1
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

1065-1071

Informations de copyright

© Copyright by the American Board of Family Medicine.

Déclaration de conflit d'intérêts

Conflict of interest: none.

Auteurs

Xinyan Cai (X)

From Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA(XC, MHE); University of Georgia Health Science Center, Athens, GA (GR).

Mark H Ebell (MH)

From Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA(XC, MHE); University of Georgia Health Science Center, Athens, GA (GR). ebell@uga.edu.

Garth Russo (G)

From Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA(XC, MHE); University of Georgia Health Science Center, Athens, GA (GR).

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › A Quantitative Study of the Decision Threshold...
questionsmedicales.fr › Maladies du système immunitaire › Syndromes immunoprolifératifs › Syndromes lymphoprolifératifs › Mononucléose infectieuse › A Quantitative Study of the Decision Threshold...
questionsmedicales.fr › Maladies oto-rhino-laryngologiques › Maladies du pharynx › Pharyngite › A Quantitative Study of the Decision Threshold...
questionsmedicales.fr › Techniques d'investigation › Techniques immunologiques › Tests immunologiques › Tests sérologiques › A Quantitative Study of the Decision Threshold...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Personnel de santé › Médecins › A Quantitative Study of the Decision Threshold...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › A Quantitative Study of the Decision Threshold...