Rietveld et al developed a score to help determine if infectious conjunctivitis is due to a bacterial infection. This can help to select patients for antibiotic therapy. The authors are from the University of Amsterdam.
Patient selection: adults with either purulent discharge or glued eyelid
Parameters:
(1) number of "glued" eyes in the early morning
(2) itching
(3) history of "conjunctivitis" (not very well defined)
Parameter
Finding
Points
number of glued eyes
both (2)
5
one (1)
2
neither (0)
0
itching
absent
0
present
-1
history of conjunctivitis
absent
0
present
-2
total score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: -3
• maximum score: 5
• A patient with a score >= +2 was diagnosed as having a bacterial conjunctivitis and treated with ophthalmic antibiotics.
Performance:
• A score >= +2 had a sensitivity of 67% and specificity of 73% (Youden Index 0.4), which is not terribly good, although no doubt better than some clinical judgment.
Limitations:
• It would have been interesting (at least to me) to know if results of a Gram stain could have improved performance.
• Clinical recognition of conjunctivitis as infectious may not be a gold standard.
• The study excluded patients with contact lenses and children.
• There are 2 different ways of looking at this problem. One is what is the most cost effective approach from delivery of care assuming rational individuals. An alternative approach is to determine the liability for one person not being treated who should have been treated and who became blind? Considering that 33% of people with bacterial infection (about 300,000 people in the Netherlands) would not have been treated this would be a significant risk for a large population. You would only need 10 lawsuits to make giving everyone antibiotics seem like a deal.
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