The Composite Q Score of Bartlett for Determining Specimen Quality

 

Specimen selection: A specimen from the lower respiratory tract or a superficial wound.

 

Gram stain examination: 10 to 20 low power (10x objective) microscopic fields

 

Parameters:

(1) average number of neutrophils present per low power field

(2) average number of squamous cells present per low power field

(3) presence of ciliated respiratory epithelial cells if a sputum specimen

(4) leukopenia due to disease or therapy

Parameter	Finding	Points
average number of neutrophils	0 (none)	0
	1 to 9 (few)	+1
	10 - 24 (moderate numbers)	+2
	>= 25 (many, numerous)	+3
average number of squamous cells	0 (none)	0
	1 to 9 (few)	-1
	10 - 24 (moderate numbers)	-2
	>= 25 (many, numerous)	-3

 

composite Q score =

= (points for average number of neutrophils) + (points for average number of squamous cells)

 

Interpretation:

• minimum score: -3

• maximum score: +3

• The higher the score the better the specimen.

• A specimen with a composite score >= +1 should be cultured.

• A sputum specimen from a leukopenic patient with ciliated respiratory epithelial cells should be cultured.

• A composite Q score that is 0 or negative is probably a superficial sample that may not be a reliable specimen and so is usually not cultured.