Evaluation of risk score algorithms for detection of chlamydial and gonococcal infections in an emergency department setting.
OBJECTIVE
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.
Al-Tayyib
Alia A
AA
Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. alia.al-tayyib@dhha.org
Miller
William C
WC
Rogers
Susan M
SM
Leone
Peter A
PA
Law
Dionne C Gesink
DC
Ford
Carol A
CA
Rothman
Richard E
RE
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000465:Algorithms; D015142:Baltimore / Q000453:epidemiology; D002690:Chlamydia Infections / Q000175:diagnosis / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening; D015995:Prevalence; D012306:Risk; D014505:Urban Population