Published Scoring System Research Articles

Contamination of central venous catheters in immunocompromised patients: a comparison between two different types of central venous catheters

Catheters impregnated with silver have been proposed as a means of reducing catheter-related infection. We therefore performed a prospective randomized study to compare a new silver-impregnated central venous catheter (CVC) with a commercially available CVC in a cohort of immunocompromised patients. We studied 157 patients of whom 97 could be analysed. The median indwelling time in the study group (SC) was 10.5 days and 11 days in the control group (CC). The incidence of contamination in the SC group was 15.6 vs 24.6 in the CC group referring to 1000 catheter days. In both groups, we found 6% of catheter-related infections according to the definitions of a published scoring system. The differences between the two groups were not significant. We conclude that the SC decrease the incidence of catheter contamination and may have a positive effect on the reduction of CVC-related infections.

Non-PBC, Non-PSC autoimmune cholangiopathy

The most challenging aspect of determining the appropriate treatment for patients with an autoimmune cholangiopathy is often establishing the diagnosis. In particular, discerning between autoimmune cholangitis (AIC)/ anti-mitochondrial antibody (AMA)-negative primary biliary cirrhosis and autoimmune hepatitis (AIH) can be difficult because of occasional overlapping histological and serological features. This distinction, however, has important therapeutic implications because the appropriate therapy for the former is ursodiol, whereas for AIH it is corticosteroids. Diagnosis of these two entities in difficult cases can be facilitated by use of a published scoring system for AIH [1,2]. In the end, it is up to the clinician to determine the predominant syndrome and initiate therapy accordingly. When in doubt, ursodiol is better tolerated as a long-term therapy than corticosteroids. Consequences of chronic cholestasis, such as pruritus, osteoporosis, hyperlipidemias, and vitamin deficiencies, are best monitored and treated in the same manner as for patients with AMA-positive PBC until further clinical studies are completed.

Evaluation of a Scoring System for Leukocyte Esterase-Nitrite Dipstick Screening for Urine Culture

A published scoring system based on four performance characteristics of a laboratory test—sensitivity, specificity, and predictive value of a negative and a positive test—was evaluated to determine whether it could be applied to the problem of eliminating routine urine culture based on leukocyte esterase-nitrite (LE/N) dipstick urine findings. Equal weight was assigned to each of the four performance characteristics, and a scoring scale ofl 00 was used for simplicity. A positive urine culture was defined as more than 105 colony-forming units per milliliter. Urine studies from the medical literature were assigned, based on the published scoring system, into one of three categories: accept, more than 80; conditional accept, 70 to 80; and reject, less than 70. Agreement between the published scoring system and author (empirical) acceptability was good for urine studies with scores of greater than 80 or less than 70. Agreement for urine studies with scores between 70 and 80 was not good (∼40% disagreement), which lead us to designate this range as “equivocal.” The published scoring system used for assessing the feasibility of eliminating routine urine microscopy based on dipstick urine findings cannot be applied without modification to urine studies that assess the feasibility of eliminating routine urine culture based on LE/N dipstick findings. The following set of recommendations are proposed as a guide to provide a rational basis for accepting or rejecting LE/N screening for urine culture: accept if the score is more than 80; equivocal if the score is 70 to 80; accept if cost savings (reagent and technician time) is of primary importance, reject if sensitivity is unacceptably low; and reject if the score is less than 70.