Osorio Lyda, Uribe Marcela, Ardila Gloria Ines, Orejuela Yaneth, Velasco Margarita, Bonelo Anilza, Parra Beatriz
Escuela de Salud Pública, Universidad del Valle, Cali, Colombia.
Laboratorio Especializado, Caja de Compensación Familiar del Valle del Cauca, Cali, Colombia.
Mem Inst Oswaldo Cruz. 2015 Jun;110(4):510-6. doi: 10.1590/0074-02760140359. Epub 2015 May 15.
There is insufficient evidence of the usefulness of dengue diagnostic tests under routine conditions. We sought to analyse how physicians are using dengue diagnostics to inform research and development. Subjects attending 14 health institutions in an endemic area of Colombia with either a clinical diagnosis of dengue or for whom a dengue test was ordered were included in the study. Patterns of test-use are described herein. Factors associated with the ordering of dengue diagnostic tests were identified using contingency tables, nonparametric tests and logistic regression. A total of 778 subjects were diagnosed with dengue by the treating physician, of whom 386 (49.5%) were tested for dengue. Another 491 dengue tests were ordered in subjects whose primary diagnosis was not dengue. Severe dengue classification [odds ratio (OR) 2.2; 95% confidence interval (CI) 1.1-4.5], emergency consultation (OR 1.9; 95% CI 1.4-2.5) and month of the year (OR 3.1; 95% CI 1.7-5.5) were independently associated with ordering of dengue tests. Dengue tests were used both to rule in and rule out diagnosis. The latter use is not justified by the sensitivity of current rapid dengue diagnostic tests. Ordering of dengue tests appear to depend on a combination of factors, including physician and institutional preferences, as well as other patient and epidemiological factors.
在常规条件下，登革热诊断检测的有用性证据不足。我们试图分析医生如何使用登革热诊断方法来为研发提供信息。研究纳入了在哥伦比亚一个流行地区的14家医疗机构就诊的受试者，这些受试者要么临床诊断为登革热，要么被要求进行登革热检测。本文描述了检测使用模式。使用列联表、非参数检验和逻辑回归确定与登革热诊断检测医嘱相关的因素。治疗医生共诊断出778例登革热患者，其中386例（49.5%）接受了登革热检测。在初步诊断不是登革热的受试者中，又开出了491份登革热检测医嘱。严重登革热分类（优势比[OR]2.2；95%置信区间[CI]1.1 - 4.5）、急诊会诊（OR 1.9；95% CI 1.4 - 2.5）和一年中的月份（OR 3.1；95% CI 1.7 - 5.5）与登革热检测医嘱独立相关。登革热检测既用于确诊也用于排除诊断。目前快速登革热诊断检测的敏感性无法证明后者的用途合理。登革热检测医嘱似乎取决于多种因素的组合，包括医生和机构的偏好，以及其他患者和流行病学因素。
