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Development and Validation of a simple score for diagnosis of Leptospirosis at outpatient departments.

ABSTRACT: BACKGROUND:Leptospirosis is an important zoonotic disease within the tropics. Diagnosing leptospirosis is a clinical obstacle, as clinical presentations are similar to other tropical infectious diseases. Available serological tests are often insensitive and not cost-effective. Many clinical diagnostic scorings had been developed but most were based on hospitalized patients, and wound not be suitable for use in suspected patients in setting of ambulatory care. OBJECTIVES:To develop and internal validate multivariable diagnostic prediction score of leptospirosis in patients suspicious of leptospirosis at out-patient clinics of community hospitals. MATERIALS AND METHODS:We performed a prospective, multisite diagnostic prediction research with development of a diagnostic score. The development cohort was based on patients suspicious of leptospirosis who visited five community hospitals in Si Sa Ket province, Thailand during December 2017 to November 2018. Leptospirosis confirmed cases were defined when one of the three standard confirmatory tests was positive. Multivariable logistic regression was used for score derivation. Test of AuROC equality was done to compare diagnostic performance of the newly derived score and conventional WHO score. RESULTS:A total of 262 leptospirosis suspicious patients were enrolled. Eighty-two patients (31.5%) were leptospirosis confirmed cases. Five final predictors remained within the reduced logistic model which were history of exposure to wet ground at workplace, history of contact water reservoir used by animal, urine protein and urine blood positive from dipstick test, and neutrophil count from CBC ?80%. The OPD score diagnostic performance was AuROC 0.72 (95%CI 0.65-0.79). Test of equality revealed significant differences of AuROC between the OPD and WHO score (0.72 vs 0.62, p-value 0.014). Patients were categorized into low and high probability of having leptospirosis at score point of 3.5 with sensitivity 72.4% and specificity 61.7%. CONCLUSIONS:This study developed and internal validated the OPD score. This clinical risk score could be one of the important tools for diagnosis of leptospirosis at the outpatient clinic.

SUBMITTER: Temeiam N

PROVIDER: S-EPMC6975559 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Development and Validation of a simple score for diagnosis of Leptospirosis at outpatient departments.

Temeiam Nidhikul N Jareinpituk Sutthi S Phinyo Phichayut P Patumanond Jayanton J Srisawat Nattachai N

PLoS neglected tropical diseases 20200109 1

<h4>Background</h4>Leptospirosis is an important zoonotic disease within the tropics. Diagnosing leptospirosis is a clinical obstacle, as clinical presentations are similar to other tropical infectious diseases. Available serological tests are often insensitive and not cost-effective. Many clinical diagnostic scorings had been developed but most were based on hospitalized patients, and wound not be suitable for use in suspected patients in setting of ambulatory care.<h4>Objectives</h4>To develop ...[more]

PMID: 31917796

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Project description:Background and aimsTo improve management of patients with Crohn's disease, objective measurements of disease activity are needed. Ileocolonoscopy is the current reference standard but has limitations that restrict repeated use. Ultrasonography is potentially useful for activity monitoring, but no validated sonographic activity index is currently in widespread use. Thus, we aimed to construct and validate a simple ultrasound score for Crohn's disease.MethodsForty patients were prospectively examined with ultrasound and endoscopy in the development phase. The Simple Endoscopic Score for Crohn's Disease [SES-CD] was used as a reference standard. Seven ultrasound variables [bowel wall thickness, length, colour Doppler, stenosis, fistula, stratification and fatty wrapping] were initially included, and multiple linear regression was used to select the variables that should be included in the final score. Second, the ultrasound data from each patient were re-examined for interobserver assessment using weighted kappa and intraclass correlation. Finally, the activity index was validated in a new cohort of 124 patients.ResultsLength, fistula and stenosis were excluded. The combination of the remaining variables provided a multiple correlation coefficient of r = 0.78. Interobserver analysis revealed poor agreement for stratification and fatty wrapping and these were thus excluded. There was excellent interobserver agreement for the remaining score consisting of wall thickness and colour Doppler. In both patient cohorts, the ultrasound score correlated well with SES-CD [Development cohort: rho = 0.83, p < 0.001, Validation cohort: rho = 0.78, p < 0.001]. A receiver operating characteristic curve analysis revealed an area under the curve of 0.92 and 0.88 for detecting endoscopic activity and moderate endoscopic activity, respectively.ConclusionsA simple ultrasound activity index for Crohn's disease consisting of bowel wall thickness and colour Doppler was constructed and validated and correlated well with endoscopic disease activity.ClinicalTrials. gov ID: NCT03481751.

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Development and Validation of a simple score for diagnosis of Leptospirosis at outpatient departments.

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Development and Validation of a simple score for diagnosis of Leptospirosis at outpatient departments.

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