Your browser doesn't support javascript.
Derivation and validation of clinical prediction rules for diagnosis of infectious mononucleosis: a prospective cohort study.
de Paor, Muireann; Boland, Fiona; Cai, Xinyan; Smith, Susan; Ebell, Mark H; Mac Donncha, Eoin; Fahey, Tom.
  • de Paor M; HRB Centre For Primary Care Research, Division of Population Health Sciences (PHS), Royal College of Surgeons Ireland, Dublin, Ireland muireann.depaor@hse.ie.
  • Boland F; HRB Centre For Primary Care Research, Division of Population Health Sciences (PHS), Royal College of Surgeons Ireland, Dublin, Ireland.
  • Cai X; Epidemiology and Biostatistics, University of Georgia, Athens, Georgia, USA.
  • Smith S; Community Health and General Practice, Trinity College Dublin, Dublin, Ireland.
  • Ebell MH; Epidemiology and Biostatistics, University of Georgia, Athens, Georgia, USA.
  • Mac Donncha E; Student Health Unit, National University of Ireland Galway, Galway, Ireland.
  • Fahey T; HRB Centre For Primary Care Research, Division of Population Health Sciences (PHS), Royal College of Surgeons Ireland, Dublin, Ireland.
BMJ Open ; 13(2): e068877, 2023 02 27.
Article in English | MEDLINE | ID: covidwho-2317984
ABSTRACT

OBJECTIVES:

Infectious mononucleosis (IM) is a clinical syndrome that is characterised by lymphadenopathy, fever and sore throat. Although generally not considered a serious illness, IM can lead to significant loss of time from school or work due to profound fatigue, or the development of chronic illness. This study aimed to derive and externally validate clinical prediction rules (CPRs) for IM caused by Epstein-Barr virus (EBV).

DESIGN:

Prospective cohort study. SETTING AND

PARTICIPANTS:

328 participants were recruited prospectively for the derivation cohort, from seven university-affiliated student health centres in Ireland. Participants were young adults (17-39 years old, mean age 20.6 years) with sore throat and one other additional symptom suggestive of IM. The validation cohort was a retrospective cohort of 1498 participants from a student health centre at the University of Georgia, USA. MAIN OUTCOME

MEASURES:

Regression analyses were used to develop four CPR models, internally validated in the derivation cohort. External validation was carried out in the geographically separate validation cohort.

RESULTS:

In the derivation cohort, there were 328 participants, of whom 42 (12.8%) had a positive EBV serology test result. Of 1498 participants in the validation cohort, 243 (16.2%) had positive heterophile antibody tests for IM. Four alternative CPR models were developed and compared. There was moderate discrimination and good calibration for all models. The sparsest CPR included presence of enlarged/tender posterior cervical lymph nodes and presence of exudate on the pharynx. This model had moderate discrimination (area under the receiver operating characteristic curve (AUC) 0.70; 95% CI 0.62-0.79) and good calibration. On external validation, this model demonstrated reasonable discrimination (AUC 0.69; 95% CI 0.67-0.72) and good calibration.

CONCLUSIONS:

The alternative CPRs proposed can provide quantitative probability estimates of IM. Used in conjunction with serological testing for atypical lymphocytosis and immunoglobulin testing for viral capsid antigen, CPRs can enhance diagnostic decision-making for IM in community settings.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Pharyngitis / Epstein-Barr Virus Infections / Infectious Mononucleosis Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study Limits: Adolescent / Adult / Humans / Young adult Language: English Journal: BMJ Open Year: 2023 Document Type: Article Affiliation country: Bmjopen-2022-068877

Similar

MEDLINE

...
LILACS

LIS


Full text: Available Collection: International databases Database: MEDLINE Main subject: Pharyngitis / Epstein-Barr Virus Infections / Infectious Mononucleosis Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study Limits: Adolescent / Adult / Humans / Young adult Language: English Journal: BMJ Open Year: 2023 Document Type: Article Affiliation country: Bmjopen-2022-068877