Steckelberg J M, Melton L J, Ilstrup D M, Rouse M S, Wilson W R
Division of Infectious Diseases, Mayo Clinic and Foundation, Rochester, Minnesota 55905.
Am J Med. 1990 Jun;88(6):582-8. doi: 10.1016/0002-9343(90)90521-e.
To assess the effect of referral bias on the clinical spectrum of infective endocarditis.
We performed a retrospective study comparing a population-based cohort of incidence cases from Olmsted County, Minnesota, with a cohort of referred cases from the practice of the Mayo Clinic during the period from 1970 to 1987.
In the community cohort, age was an important risk factor for acquiring endocarditis (incidence rate ratio 8.8:1 for age 65 years or older versus age less than 65 years), but episodes in elderly patients were underrepresented in the referral practice. The proportion of cases due to Staphylococcus aureus was greater in the community than in the referral practice (p less than 0.02), while a trend toward overrepresentation of enterococcal endocarditis was seen in the referral population (p = 0.057). Symptom duration prior to diagnosis was significantly shorter in the community. Overall, measures of in-hospital morbidity and mortality were similar in the two populations, but advanced age was associated with adverse outcome in the community cohort.
The clinical spectrum of infective endocarditis may be distorted by referral. The increased risk of endocarditis in the elderly underscores the importance of adherence to recommendations for prophylaxis in this patient population.
评估转诊偏倚对感染性心内膜炎临床谱的影响。
我们进行了一项回顾性研究，比较了明尼苏达州奥尔姆斯特德县基于人群的发病病例队列与1970年至1987年期间梅奥诊所转诊病例队列。
在社区队列中，年龄是患心内膜炎的重要危险因素（65岁及以上人群与年龄小于65岁人群的发病率比为8.8:1），但老年患者的发病情况在转诊实践中未得到充分体现。社区中由金黄色葡萄球菌引起的病例比例高于转诊实践（p<0.02），而在转诊人群中肠球菌性心内膜炎有比例过高的趋势（p = 0.057）。社区中诊断前症状持续时间明显较短。总体而言，两个队列的住院发病率和死亡率指标相似，但在社区队列中高龄与不良结局相关。
转诊可能会使感染性心内膜炎的临床谱发生扭曲。老年人患心内膜炎风险增加凸显了在该患者群体中遵循预防建议的重要性。
