Fornes Vivas Rosa, Robledo Díaz Luis, Carvajal Roca Eva, Navarro Juanes Agustín, Pérez Feito Carlos
Hospital Católico Universitario Casa de Salud. Valencia. España.
Departamento de Sociología y Antropología Social. Facultad de Ciencias Sociales. Universidad de Valencia. Valencia. España.
Rev Esp Salud Publica. 2019 Nov 20;93:e201911061.
There are two scales (Centor and McIsaac) that describe the frequent signs and symptoms in pharyngotonsillitis and determine the attitude to be followed for diagnosis and treatment; among them, the McIsaac criteria are one of the most widely used scales. The goal of the study was to determine the predictive value of the McIsaac criteria in the diagnosis of pharyngotonsillitis due to EbhGA in a Pediatric Emergency Service. The predictive value of these criteria is decisive in the adequate use of TDR test and antibiotics as a treatment.
Cross-sectional study. The target population were all patients between 0 and 14 years old treated in the Pediatric Emergency Service of the Casa de Salud Hospital of Valencia during 2016, with discharge diagnoses, tonsillitis, pharyngotonsillitis or pharyngitis and with the TDR performed. Two groups were set up according to whether TDR was positive or negative. The presence of the McIsaac criteria was studied in both groups. A sensitivity and specificity study was carried out and the Total and Bayes Probability theorems were applied as well as the likelihood ratio measures.
A negative result of TDR was obtained in 58.1% (n=330) and was obtained a positive result in 41.9% (n=238). At least three criteria met 48.3% (n=115) with TDR+ of which the most frequent was age >3 years (97.4%); and 46.7% (n=154) of children with TDR- where the most frequent was the absence of catarrh (91.6%). The output from the predictive analysis of meeting the McIsaac criteria was a sensitivity (P(+/E)=48.3%), a specificity (P(-/NE)=53.3%), a positive predictive value P(E/+)=42.7% and likelihood ratios LR+=1.04 and LR-=0.97.
The results indicate a poor predictive value of the McIsaac criteria in the population being studied. The TDR test should be implanted more frequently and the McIsaac criteria should be re-evaluated for the correct diagnosis of pharyngotonsillitis due to EbhGA and with it an adequate treatment to avoid the overprescription of antibiotics.
有两种量表（森托量表和麦基萨克量表）描述了咽扁桃体炎常见的体征和症状，并确定了诊断和治疗应遵循的方法；其中，麦基萨克标准是使用最广泛的量表之一。本研究的目的是确定麦基萨克标准在儿科急诊服务中对埃布氏嗜血杆菌引起的咽扁桃体炎诊断的预测价值。这些标准的预测价值对于妥当地使用TDR检测和抗生素进行治疗具有决定性意义。
横断面研究。目标人群为2016年在巴伦西亚卡萨德萨尔杜医院儿科急诊服务中接受治疗的所有0至14岁患者，出院诊断为扁桃体炎、咽扁桃体炎或咽炎，并进行了TDR检测。根据TDR结果为阳性或阴性分为两组。研究两组中麦基萨克标准的存在情况。进行了敏感性和特异性研究，并应用了全概率定理和贝叶斯概率定理以及似然比测量。
TDR检测结果为阴性的占58.1%（n = 330），阳性的占41.9%（n = 238）。TDR阳性的患者中至少符合三项标准的占48.3%（n = 115），其中最常见的是年龄>3岁（97.4%）；TDR阴性的儿童中占46.7%（n = 154），其中最常见的是无卡他症状（91.6%）。符合麦基萨克标准的预测分析结果为敏感性（P(+/E)=48.3%）、特异性（P(-/NE)=53.3%）、阳性预测值P(E/+)=42.7%以及似然比LR+=1.04和LR-=0.97。
结果表明麦基萨克标准在所研究人群中的预测价值较差。应更频繁地开展TDR检测，并且应重新评估麦基萨克标准，以便正确诊断埃布氏嗜血杆菌引起的咽扁桃体炎，并据此进行适当治疗，避免抗生素的过度处方。
