Abstract
BackgroundThe aim of the present study was to develop a clinical scoring system for the diagnosis of hand-foot-mouth disease (HFMD) with improved accuracy.MethodsA retrospective analysis was performed on standardized patient history and clinical examination data obtained from 1435 pediatric patients under the age of three years who presented with acute rash illness and underwent enterovirus nucleic acid detection. Patients were then divided into the HFMD (1094 patients) group or non-HFMD (341 patients) group based on a positive or a negative result from the assay, respectively. We then divided the data into a training set (1004 cases, 70%) and a test set (431 cases, 30%) using a random number method. Multivariate logistic regression was performed on 15 clinical variables (e.g. age, exposure history, number of rash spots in a single body region) to identify variables highly predictive of a positive diagnosis in the training set. Using the variables with high impact on the diagnostic accuracy, we generated a scoring system for predicting HFMD and subsequently evaluated this system in the test set by receiver operating characteristic curve (ROC curve).ResultsUsing the logistic model, we identified seven clinical variables (age, exposure history, and rash density at specific regions of the body) to be included into the scoring system. The final scores ranged from − 5 to 24 (higher scores positively predicted HFMD diagnosis). Through our training set, a cutoff score of 7 resulted in a sensitivity of 0.76 and specificity of 0.68. The area under the receiver operating characteristic curve (AUC) was 0.804 (95% confidence interval [CI]: 0.773–0.835) (P < 0.001). Using the test set, we obtained an AUC of 0.76 (95% CI: 0.710–0.810) with a sensitivity of 0.76 and a specificity of 0.62. These results from the test set were consistent with those from the training set.ConclusionsThis study establishes an objective scoring system for the diagnosis of typical and atypical HFMD using measures accessible through routine clinical encounters. Due to the accuracy and sensitivity achieved by this scoring system, it can be employed as a rapid, low-cost method for establishing diagnoses in children with acute rash illness.
Highlights
The aim of the present study was to develop a clinical scoring system for the diagnosis of hand-footmouth disease (HFMD) with improved accuracy
Health care settings lacking this resource must continue to rely on clinical markers of the disease. In this retrospective study of more than 1400 children with acute rash illness, we analyzed multiple clinical variables to devise a scoring system that relies on elements that can be obtained during a routine patient encounter
A total of 1435 (823 males) patients were included in this study, where 1094 patients tested positive (HFMD group) for enterovirus RNA while 341 patients tested negative (Table 1)
Summary
The aim of the present study was to develop a clinical scoring system for the diagnosis of hand-footmouth disease (HFMD) with improved accuracy. Associated pathogens include enterovirus, measles virus, Huang et al BMC Infectious Diseases (2021) 21:722 maculopapular rash, blisters, and/or ulcers in the mouth, hands, feet, and buttocks [8], HFMD can exhibit unusual cutaneous manifestations that may be difficult to differentiate from other viral exanthemas [9,10,11]. For this reason, increased accuracy in diagnosing atypical HFMD will improve triage, treatment, and isolation of affected patients. No studies have systematically investigated or identified clinical variables predictive of HFMD
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