From Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA(XC, MHE); University of Georgia Health Science Center, Athens, GA (GR).
J Am Board Fam Med. 2022 Dec 23;35(6):1065-1071. doi: 10.3122/jabfm.2022.210185R1. Epub 2022 Dec 16.
Ordering a serologic test for infectious mononucleosis (IM) in all young patients with sore throat is costly and impractical. The test threshold to determine when to order a diagnostic test for IM based on the patient's symptoms has not been previously studied.
To determine the test threshold for IM in the management of patients with sore throat.
Online surveys were sent to a convenience sample of US primary care clinicians regarding their decision making about whether or not to order a test for IM in a patient with sore throat.
7 clinical vignettes were created, each with a different combinations of symptoms and signs. The probability of IM for each vignette was estimated by the investigator based on the number of symptoms present to generate a plausible range of disease probabilities. Clinicians were then asked to decide whether to test or not test for IM, and mixed-effect logistic regression was used to determine the test threshold for IM where half of physicians chose to test and half chose not to test.
A total of 117 clinicians provided responses for a total of 819 clinical vignettes. The overall test threshold for IM as estimated using the logistic regression was 9.5% (95% CI: 8.2% to 10.9%). The test threshold for clinicians practicing greater than 10 years was significantly higher than for those practicing less or equal to 10 years (10.5% vs 7.3%, ). No significant differences between specialties and practice sites were found with respect to the test threshold.
This study identified a test threshold for IM of approximately 10% based on realistic clinical vignettes. This threshold was stable regarding the clinician's specialty and practice sites and could be used in the development of a clinical prediction rule to determine the cutoff for low- versus high-risk groups.
对所有有咽痛的年轻患者进行传染性单核细胞增多症（IM）的血清学检测既昂贵又不切实际。之前尚未研究过根据患者症状确定何时进行 IM 诊断检测的检测阈值。
确定用于管理咽痛患者的 IM 检测阈值。
向美国初级保健临床医生的便利样本发送了在线调查，以了解他们是否决定对有咽痛的患者进行 IM 检测。
创建了 7 个临床案例，每个案例都有不同的症状和体征组合。根据存在的症状数量，调查人员估计每个案例的 IM 概率，以生成疾病概率的合理范围。然后，临床医生被要求决定是否进行 IM 检测，使用混合效应逻辑回归来确定 IM 检测的阈值，其中一半医生选择进行检测，另一半选择不进行检测。
共有 117 名临床医生对总共 819 个临床案例做出了回应。使用逻辑回归估计的 IM 总体检测阈值为 9.5%（95%CI：8.2%至 10.9%）。执业时间超过 10 年的医生的检测阈值明显高于执业时间少于或等于 10 年的医生（10.5%比 7.3%）。在专业和实践地点方面，检测阈值没有显著差异。
本研究根据现实的临床案例确定了 IM 的检测阈值约为 10%。该阈值在临床医生的专业和实践地点方面是稳定的，可以用于制定临床预测规则，以确定低风险和高风险组的截止值。
