Parthasarathy Raghavan, Kumar Rakesh, Gopal Giridara, Amarchand Ritvik, Broor Shobha, Choudekar Avinash, Purakayastha Debjani Ram, Wahi Abhishek, Narayan Venkatesh Vinayak, Krishnan Anand
Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India.
Centre for Chronic Diseases Control, Gurugram, Haryana, India.
J Family Med Prim Care. 2020 Oct 30;9(10):5136-5141. doi: 10.4103/jfmpc.jfmpc_759_20. eCollection 2020 Oct.
Sore throat is one of the commonest symptoms that patients present to a primary care physician. We describe the epidemiology of sore throat and performance of an algorithm to predict viral sore throat in a part of India.
Children below 10 years of age were followed in 4 villages of Haryana, India from Aug 2012 to Aug 2014 through weekly domiciliary visits by trained field workers who screened for symptoms of acute respiratory infection (ARI) including sore throat. Nasal and throat swabs were obtained from a random sample of sore throat cases by nurses and sent in appropriate transport media for real-time polymerase chain reaction for detection of viral nucleic acid. Incidence of sore throat and viral sore throat are reported as number of sore throat episodes per 1000 child-years (EPTCY) with 95% confidence-interval (CI). Symptoms, associated with viral sore throat were identified by logistic regression, combined into a clinical score and Receiver Operating Characteristic curve was plotted.
Over a two-year period, 3765 children were followed up for 5578 child years. 1069 episodes of sore throat were reported, and swabs were collected from 8% of the cases randomly. The incidence of sore throat and viral sore throat was 191.7 (95%CI: 180.5-203.6) and 60.1 (95%CI: 55.1-68.2) EPTCY, respectively. Fever (aOR 5.40,95%CI: 1.16-25.18) and running nose (aOR 10.16,95%CI: 1.01-102.42) was significantly associated with viral sore throat. The clinical score (fever, running nose, and headache) had an overall sensitivity of 86.2% (68.3-96.1%), specificity of 62% (47.2-75.3%) and AUC of 0.78 (0.67-0.87) in predicting viral sore throat.
Viruses contributed to one-third of burden of sore throat and clinical score can be used in primary care settings to aid antibiotic prescription by physicians.
喉咙痛是患者向初级保健医生提出的最常见症状之一。我们描述了印度某地区喉咙痛的流行病学情况以及一种预测病毒性喉咙痛算法的性能。
2012年8月至2014年8月期间，印度哈里亚纳邦的4个村庄对10岁以下儿童进行了随访，训练有素的现场工作人员每周进行家访，筛查包括喉咙痛在内的急性呼吸道感染（ARI）症状。护士从喉咙痛病例的随机样本中采集鼻拭子和咽拭子，并在适当的运输培养基中送检，用于实时聚合酶链反应检测病毒核酸。喉咙痛和病毒性喉咙痛的发病率报告为每1000儿童年的喉咙痛发作次数（EPTCY），并给出95%置信区间（CI）。通过逻辑回归确定与病毒性喉咙痛相关的症状，合并为临床评分，并绘制受试者工作特征曲线。
在两年期间，对3765名儿童进行了5578儿童年的随访。报告了1069次喉咙痛发作，随机抽取8%的病例采集了拭子。喉咙痛和病毒性喉咙痛的发病率分别为191.7（95%CI：180.5 - 203.6）和60.1（95%CI：55.1 - 68.2）EPTCY。发热（调整后比值比5.40，95%CI：1.16 - 25.18）和流鼻涕（调整后比值比10.16，95%CI：1.01 - 102.42）与病毒性喉咙痛显著相关。临床评分（发热、流鼻涕和头痛）在预测病毒性喉咙痛方面的总体敏感性为86.2%（68.3 - 96.1%），特异性为62%（47.2 - 75.3%），曲线下面积为0.78（0.67 - 0.87）。
病毒导致了三分之一的喉咙痛负担，临床评分可在初级保健环境中帮助医生进行抗生素处方。
