Nambiar Tarun, Zaveri Sanskruti, Thornley Simon, Selak Vanessa, Sundborn Gerhard, Pasay Cielo, Morris Arthur J
Department of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
Department of Pacific Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
J Paediatr Child Health. 2025 Feb;61(2):216-222. doi: 10.1111/jpc.16738. Epub 2024 Dec 9.
We sought to determine the degree of agreement between clinical and laboratory methods for diagnosing scabies in school-aged children.
Clinical information and samples were collected from children aged 7 months to 14 years attending educational institutions in Auckland, New Zealand. Two methods determined scabies status: the International Alliance for the Control of Scabies clinical criteria (IACS) and quantitative polymerase chain reaction (qPCR). Sensitivity and specificity of each method, as the reference or index standard, were estimated and agreement was determined using Cohen's kappa statistic.
Sixteen of 145 children were positive based on IACS criteria and 15 of 64 with a suspicious skin lesion returned a positive qPCR test. IACS sensitivity and specificity were 66.7% (95% confidence interval (CI): 39.9-93.3) and 94% (95% CI: 89.9-98.0), respectively (with qPCR as the reference). For qPCR, sensitivity and specificity were 50% (95% CI: 25.5-74.5) and 96.9% (95% CI: 94.0-100.0), respectively (with IACS as the reference). The kappa value was 0.53.
Agreement between clinical and laboratory methods in the identification of scabies diagnosis was moderate. Both methods had low sensitivity but high specificity. Scabies diagnosis might be improved, thereby enhancing control measures, by relaxing the IACS criteria (as some IACS-negative participants returned positive qPCR tests, indicating mite DNA was present) and conversely supplementing clinical assessment with qPCR testing.
我们试图确定诊断学龄儿童疥疮的临床方法与实验室方法之间的一致性程度。
从新西兰奥克兰的教育机构中7个月至14岁的儿童收集临床信息和样本。两种方法用于确定疥疮状况：国际疥疮控制联盟临床标准（IACS）和定量聚合酶链反应（qPCR）。估计每种方法作为参考或指标标准的敏感性和特异性，并使用科恩kappa统计量确定一致性。
根据IACS标准，145名儿童中有16名呈阳性，64名有可疑皮肤病变的儿童中有15名qPCR检测呈阳性。以qPCR为参考时，IACS的敏感性和特异性分别为66.7%（95%置信区间（CI）：39.9 - 93.3）和94%（95%CI：89.9 - 98.0）。以IACS为参考时，qPCR的敏感性和特异性分别为50%（95%CI：25.5 - 74.5）和96.9%（95%CI：94.0 - 100.0）。kappa值为0.53。
临床方法与实验室方法在疥疮诊断识别中的一致性为中等。两种方法敏感性低但特异性高。通过放宽IACS标准（因为一些IACS阴性参与者qPCR检测呈阳性，表明存在螨虫DNA），反之通过qPCR检测补充临床评估，疥疮诊断可能会得到改善，从而加强控制措施。
