Evaluation of Risk Score Algorithms for Detection of Chlamydial and Gonococcal Infections in an Emergency Department Setting

Authors

  • Alia A. Al-Tayyib PhD,

    1. From the Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill (AAA, WCM, PAL), Chapel Hill, NC; the Division of Infectious Diseases (WCM, PAL), the Adolescent Medicine Program (CAF), and the Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; the Health and Behavior Measurement Program, RTI International (SMR), Washington, DC; the Department of Microbiology, Montana State University (DGL), Bozeman, Montana; and the Department of Emergency Medicine, The Johns Hopkins University (RER), Baltimore, MD.
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  • William C. Miller MD, PhD,

    1. From the Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill (AAA, WCM, PAL), Chapel Hill, NC; the Division of Infectious Diseases (WCM, PAL), the Adolescent Medicine Program (CAF), and the Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; the Health and Behavior Measurement Program, RTI International (SMR), Washington, DC; the Department of Microbiology, Montana State University (DGL), Bozeman, Montana; and the Department of Emergency Medicine, The Johns Hopkins University (RER), Baltimore, MD.
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  • Susan M. Rogers PhD,

    1. From the Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill (AAA, WCM, PAL), Chapel Hill, NC; the Division of Infectious Diseases (WCM, PAL), the Adolescent Medicine Program (CAF), and the Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; the Health and Behavior Measurement Program, RTI International (SMR), Washington, DC; the Department of Microbiology, Montana State University (DGL), Bozeman, Montana; and the Department of Emergency Medicine, The Johns Hopkins University (RER), Baltimore, MD.
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  • Peter A. Leone MD,

    1. From the Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill (AAA, WCM, PAL), Chapel Hill, NC; the Division of Infectious Diseases (WCM, PAL), the Adolescent Medicine Program (CAF), and the Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; the Health and Behavior Measurement Program, RTI International (SMR), Washington, DC; the Department of Microbiology, Montana State University (DGL), Bozeman, Montana; and the Department of Emergency Medicine, The Johns Hopkins University (RER), Baltimore, MD.
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  • Dionne C. Gesink Law PhD,

    1. From the Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill (AAA, WCM, PAL), Chapel Hill, NC; the Division of Infectious Diseases (WCM, PAL), the Adolescent Medicine Program (CAF), and the Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; the Health and Behavior Measurement Program, RTI International (SMR), Washington, DC; the Department of Microbiology, Montana State University (DGL), Bozeman, Montana; and the Department of Emergency Medicine, The Johns Hopkins University (RER), Baltimore, MD.
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  • Carol A. Ford MD,

    1. From the Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill (AAA, WCM, PAL), Chapel Hill, NC; the Division of Infectious Diseases (WCM, PAL), the Adolescent Medicine Program (CAF), and the Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; the Health and Behavior Measurement Program, RTI International (SMR), Washington, DC; the Department of Microbiology, Montana State University (DGL), Bozeman, Montana; and the Department of Emergency Medicine, The Johns Hopkins University (RER), Baltimore, MD.
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  • Richard E. Rothman MD

    1. From the Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill (AAA, WCM, PAL), Chapel Hill, NC; the Division of Infectious Diseases (WCM, PAL), the Adolescent Medicine Program (CAF), and the Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; the Health and Behavior Measurement Program, RTI International (SMR), Washington, DC; the Department of Microbiology, Montana State University (DGL), Bozeman, Montana; and the Department of Emergency Medicine, The Johns Hopkins University (RER), Baltimore, MD.
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  • Contact for reprints: William C. Miller, MD, PhD; e-mail: bill_miller@unc.edu.

  • Presented in part at the 16th biennial meeting of the International Society for Sexually Transmitted Diseases Research, Amsterdam, The Netherlands, July 10–13, 2005.

  • Primary support for this research was provided by an investigator initiated basic research grant from the National Institute of Child Health and Human Development to Dr. Susan Rogers (R01-HD039633).

  • At the time of the research, Ms. Al-Tayyib was funded as a Pre-Doctoral Trainee (NIAID 5 T32 A107001-28; Training in Sexually Transmitted Diseases and AIDS).

Contact for correspondence: Alia A. Al-Tayyib, PhD; e-mail: alia.al-tayyib@dhha.org.

Abstract

Objectives:  To develop and evaluate screening algorithms to predict current chlamydial and gonococcal infections in emergency department (ED) settings and assess their performance.

Methods:  Between 2002 and 2005, adult patients aged 18 to 35 years attending an urban ED were screened for Chlamydia trachomatis (Ct) and Neisseria gonorrhoeae (GC) and completed a brief demographic and behavioral questionnaire. Using multiple unconditional logistic regressions, the authors developed four separate predictive models and applicable clinical risk scores to screen for infection. They developed models for females and males separately, for Ct and GC infections combined, and for Ct infection alone. The sensitivities and specificities of the clinical risk scores at different cutoffs were used to examine performance of the algorithms.

Results:  Among 5,537 patients successfully screened for Ct and GC, the overall prevalence of infection was 9.6%. Age was the strongest predictor of infection. Adjusting for other predictors, the prevalence odds ratio (POR) was 2.2 (95% confidence interval [CI] = 1.7 to 2.8) for Ct and GC combined and 2.9 (95% CI = 2.1 to 4.1) for Ct alone comparing females 25 years and younger to females older than 25 years. Among males, the association was stronger with an adjusted POR of 3.3 (95% CI = 2.3 to 4.7) for Ct and GC combined and 3.2 (95% CI = 2.1 to 4.7) for Ct infection alone.

Conclusions:  If the decision to incorporate Ct and GC screening into routine ED care is made, age alone appears to be a sufficient screening criterion.

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