Rojas Carlos A, Weigle Kristen A, Barrera Lena, Collazos Constanza
Centro Internacional de Entrenamiento e Investigaciones Médicas, CIDEIM, AA 5390, Cali, Colombia.
Trans R Soc Trop Med Hyg. 2002 Jul-Aug;96(4):405-10. doi: 10.1016/s0035-9203(02)90375-5.
Confirmed cases of American cutaneous leishmaniasis (ACL) and other dermatological diseases were evaluated in Colombia with a clinical prediction rule independently by 3 types of evaluators: community health volunteer (CHV), practical nurse (PN) and programme physician (PP). The adapted prediction rule included 6 variables based upon clinical-historical information. The screening instrument was a rotating tower of coloured squares, one colour for each variable. A score ranging from 0 to 7, and a cutoff point of > or = 4 was selected for ACL classification (sensitivity 94.3%, specificity 53.3% and efficiency 80.3%). Disease classification, total score, and variable-specific score obtained by CHVs and PNs were compared to those obtained by a PP. The impact on case detection in the study area was assessed. Both types of primary health worker had a high agreement with the PP (sensitivity) on the classification of patients with ACL by score, CHV (92.3%) and PN (93.3%). Case detection of ACL increased 3-fold over that observed one year earlier. This screening instrument and prediction rule, when incorporated into a community surveillance programme for ACL, can facilitate greater case detection and appropriate referral for more-specific diagnostic procedures.
在哥伦比亚，由社区卫生志愿者（CHV）、执业护士（PN）和项目医生（PP）这3类评估人员，依据临床预测规则，对确诊的美洲皮肤利什曼病（ACL）及其他皮肤病病例进行了独立评估。经过调整的预测规则包含基于临床病史信息的6个变量。筛查工具是一个彩色方块旋转塔，每个变量对应一种颜色。选择了0至7分的评分范围，并选取≥4分作为ACL分类的临界值（敏感性94.3%，特异性53.3%，效率80.3%）。将CHV和PN获得的疾病分类、总分及变量特定分数，与PP获得的结果进行比较。评估了对研究区域病例检测的影响。两类初级卫生工作者在通过评分对ACL患者进行分类方面，与PP的一致性较高（敏感性），CHV为92.3%，PN为93.3%。ACL的病例检测较一年前观察到的情况增加了3倍。当将这种筛查工具和预测规则纳入ACL社区监测项目时，可促进更多病例的检测，并为更具体的诊断程序进行适当转诊。
