Objective:To find an efficient set o f diagnostic indicators that are optimally informative in th e diagnosis of a bacterial origin of acute infectious conjunctivitis.Design:Cohort study involving consecutive patien ts.Results of index tests and reference standard were collected independently from each other.Setting:25Dutch health centres.Participants:184adults presenting with a red eye a nd either(muco)purulent discharge or glued eyelid(s),not wearing contact lenses.Main outcome measures:Prob ability of a positive bacterial culture,given different combinations of index test results;area under receiver operating characteristics curv-e.Results:Logistic regression analysis showed optimal diagnostic discrimination for the c ombination of early morn-ing glued eye(s),itch,and a history of conjunctivitis.The first of these indicators increased the likelihood of a bac-terial cause,whereas the other two d ecreased it The area under the receiver operating characteristics curve for this combination of symptoms was 0.74(95%confidence in-terval 0.63to 0.80).The overall prevalence of bacteria l involvement of 32%could be lowered t o 4%or raised to77%,depending on the pattern of index test results.Conclusion:A bacterial origin of co mplaints indicative of acute infectious conjunctivitis can be made much more likely or unlikely by the answers to t hree simple questions posed during clinical history takin g(possibly by tele-phone).These results may have consequences for more targeted prescription of ocular ant ibiotics.
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