Wiesenthal A M, Ressman M, Caston S A, Todd J K
Am J Epidemiol. 1985 Nov;122(5):847-56. doi: 10.1093/oxfordjournals.aje.a114167.
Several clinical definitions of toxic shock syndrome have been proposed and used in extensive epidemiologic and clinical studies. Most of these definitions suggest (but usually do not require) that there be sufficient laboratory studies to exclude other potentially similar syndromes. Simplified definitions which broaden the spectrum of toxic shock syndrome illness have also been proposed but not validated. In this study, clinical findings of consecutive hospitalized patients were compared: nine with toxic shock syndrome (confirmed by a modification of the collaborative strict case definition) and 120 with potentially similar diagnoses (bacteremia with shock, meningococcemia, Staphylococcus aureus bacteremia, scarlet fever, toxic epidermal necrolysis, acute rheumatic fever, leptospirosis, Rocky Mountain spotted fever, rubeola, Kawasaki syndrome, erythema multiforme, and Stevens-Johnson syndrome). None of the 120 controls satisfied the clinical criteria of the modified strict definition of toxic shock syndrome, demonstrating its exclusionary properties even in the absence of additional laboratory data. A "simplified" screening definition was constructed which might be applied early in illness (i.e., at admission) and this definition distinguished all the patients with toxic shock syndrome from all but three (2.5%) of the 117 analyzable patients with other mucocutaneous or potential infectious shock syndromes. Applied prospectively in the state of Colorado passive/active reporting system, the screening definition identified 24 potential toxic shock syndrome cases of which 19 (76%) eventually were confirmed as toxic shock syndrome. Before being adopted and widely used, clinical syndrome definitions should be documented to exclude other potentially overlapping syndromes or should require additional mandatory exclusionary laboratory data.
已经提出了几种中毒性休克综合征的临床定义，并在广泛的流行病学和临床研究中使用。这些定义大多表明（但通常不要求）要有足够的实验室检查以排除其他可能类似的综合征。也有人提出了拓宽中毒性休克综合征疾病范围的简化定义，但尚未得到验证。在本研究中，对连续住院患者的临床发现进行了比较：9例中毒性休克综合征患者（通过协作严格病例定义的修改版本确诊）和120例有潜在类似诊断的患者（感染性休克伴菌血症、脑膜炎球菌血症、金黄色葡萄球菌菌血症、猩红热、中毒性表皮坏死松解症、急性风湿热、钩端螺旋体病、落基山斑疹热、麻疹、川崎综合征、多形红斑和史蒂文斯-约翰逊综合征）。120名对照患者均不符合中毒性休克综合征修改后严格定义的临床标准，这表明即使没有额外的实验室数据，该定义也具有排除性。构建了一个“简化”的筛查定义，该定义可在疾病早期（即入院时）应用，该定义将所有中毒性休克综合征患者与117例可分析的其他皮肤黏膜或潜在感染性休克综合征患者中除3例（2.5%）之外的所有患者区分开来。在科罗拉多州被动/主动报告系统中前瞻性应用时，该筛查定义识别出24例潜在的中毒性休克综合征病例，其中19例（76%）最终被确诊为中毒性休克综合征。在被采用和广泛使用之前，临床综合征定义应记录在案以排除其他可能重叠的综合征，或者应要求提供额外的强制性排除性实验室数据。
