Identifying children at low risk for bacterial conjunctivitis.
OBJECTIVE
To identify a population of children at low risk for bacterial conjunctivitis on the basis of history and physical examination findings.


METHODS
Prospective observational cohort study.


METHODS
Urban pediatric emergency department.


METHODS
Children aged 6 months to 17 years with conjunctival erythema, eye discharge, or both. The exclusion criteria were eye trauma, exposure to a noxious chemical, contact lens use, and antibiotic drug use in the past 5 days.


METHODS
Clinicians completed a checklist of signs and symptoms and collected a conjunctival swab for bacterial culture.


METHODS
The chi(2) test, the Mann-Whitney test, and logistic regression were used to create a prediction model for a negative bacterial culture.


RESULTS
Of 368 patients enrolled, 194 (52.7%) were males. The median patient age was 3 years (interquartile range, 1-5 years). Conjunctival cultures were negative in 130 patients (35.3%). Age 6 years or older, presentation in April through November, no or watery discharge, and no glued eye in the morning were the clinical factors found to be independently associated with a negative conjunctival culture. If 3 factors were present, 76.4% (95% confidence interval, 63.6%-85.6%) of patients had a negative culture. If all 4 factors were present, 92.3% (95% confidence interval, 66.1%-98.2%) of patients had a negative culture.


CONCLUSIONS
The combination of 4 clinical factors may enable clinicians to identify children at low risk for bacterial conjunctivitis and may reduce routine antibiotic drug administration.
Meltzer
James A
JA
Lewis M. Fraad Department of Pediatrics (Emergency Medicine), Jacobi Medical Center and Albert Einstein College of Medicine, 1400 Pelham Parkway S., Bronx, NY 10461, USA. jamesmeltzer@yahoo.com
Kunkov
Sergey
S
Crain
Ellen F
EF
D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003228:Conjunctiva / Q000382:microbiology; D003234:Conjunctivitis, Bacterial / Q000175:diagnosis* / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006192:Haemophilus Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D006193:Haemophilus influenzae / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D009519:New York City / Q000453:epidemiology; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000382:microbiology; D011446:Prospective Studies; D012307:Risk Factors; D013296:Streptococcus pneumoniae / Q000302:isolation & purification