title: Randomized Controlled Trial Evaluating a Standardized Strategy for Uveitis Etiologic Diagnosis (ULISSE).
abstract: OBJECTIVE
  To prospectively assess the efficiency of a standardized diagnostic approach, compared to an open strategy, for the etiologic diagnosis of uveitis.
  
  
  METHODS
  Noninferiority, prospective, multicenter, clustered randomized controlled trial.
  
  
  METHODS
  Consecutive patients with uveitis, who visited 1 of the participating departments of ophthalmology, were included. In the standardized group, all patients had a minimal evaluation regardless of the type of uveitis (complete blood count, erythrocyte sedimentation rate, C-reactive protein, tuberculin skin test, syphilis serology, and chest radiograph) followed by more complex investigations according to ophthalmologic findings. In the open group, the ophthalmologist could order any type of investigation. Main outcome was the percentage of etiologic diagnoses at 6 months.
  
  
  RESULTS
  Nine hundred and three patients with uveitis were included from January 2010 to May 2013 and the per-protocol population comprised 676 patients (open 373; standardized 303). Mean age at diagnosis was 46 years. Anatomic distribution of uveitis was as follows: anterior (60.8% and 72.3%, P = .0017), intermediate (11.7% and 12.3%, P = .8028), posterior (17.8% and 8.2%, P = .0004), and panuveitis (15.3% and 15.2%, P = .9596). An etiologic diagnosis was established in 54.4% of cases in the open group and 49.5% in the standardized group (P = .2029). The difference between both strategies (standardized minus open) was -4.9% (95% CI [-12.5%; 2.6%]). There were more investigations in the open group than in the standardized group (5371 vs 3759, P < .0001).
  
  
  CONCLUSIONS
  The standardized strategy appears to be an efficient diagnostic approach for the etiologic diagnosis of uveitis, although its noninferiority cannot be proved.
authors.affiliation: Department of Internal Medicine, Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France. Electronic address: audrey.de-parisot-de-bernecourt@chu-lyon.fr.
authors.forename: Audrey
authors.initials: A
authors.lastname: de Parisot
authors.affiliation: Department of Ophthalmology, Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Kodjikian
authors.affiliation: Department of Ophthalmology, Quinze-Vingts Hospital, Paris, France.
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Errera
authors.affiliation: Department of Internal Medicine, Quinze-Vingts Hospital, Paris, France.
authors.forename: Neila
authors.initials: N
authors.lastname: Sedira
authors.affiliation: Department of Internal Medicine, Quinze-Vingts Hospital, Paris, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Heron
authors.affiliation: Department of Internal Medicine, Edouard-Herriot Hospital, Lyon, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Pérard
authors.affiliation: Department of Ophthalmology, Edouard-Herriot Hospital, Lyon, France.
authors.forename: Pierre-Loïc
authors.initials: PL
authors.lastname: Cornut
authors.affiliation: Department of Ophthalmology, Hospital, Montpellier, France.
authors.forename: Christelle
authors.initials: C
authors.lastname: Schneider
authors.affiliation: Department of Internal Medicine, Hospital, Montpellier, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Rivière
authors.affiliation: Department of Ophthalmology, Pierre-Paul Riquet Hospital, Toulouse, France.
authors.forename: Priscille
authors.initials: P
authors.lastname: Ollé
authors.affiliation: Department of Internal Medicine, Purpan University Hospital, Toulouse, France.
authors.forename: Grégory
authors.initials: G
authors.lastname: Pugnet
authors.affiliation: Department of Internal Medicine, North Hospital, Saint-Étienne, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Cathébras
authors.affiliation: Department of Ophthalmology, North Hospital, Saint-Étienne, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Manoli
authors.affiliation: Department of Ophthalmology, Pitié-Salpêtrière Hospital, Paris, France.
authors.forename: Bahram
authors.initials: B
authors.lastname: Bodaghi
authors.affiliation: Department of Internal Medicine, Pitié-Salpêtrière Hospital, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Saadoun
authors.affiliation: Department of Ophthalmology, Archet Hospital, Nice, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Baillif
authors.affiliation: Department of Internal Medicine, Archet Hospital, Nice, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Tieulie
authors.affiliation: Department of Internal Medicine, Gabriel-Montpied Hospital, Clermont-Ferrand, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Andre
authors.affiliation: Department of Ophthalmology, Gabriel-Montpied Hospital, Clermont-Ferrand, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Chiambaretta
authors.affiliation: Department of Ophthalmology, Gabriel-Montpied Hospital, Clermont-Ferrand, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bonin
authors.affiliation: Department of Internal Medicine, General Hospital, Dijon, France.
authors.forename: Philip
authors.initials: P
authors.lastname: Bielefeld
authors.affiliation: Department of Ophthalmology, General Hospital, Dijon, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Bron
authors.affiliation: Department of Ophthalmology, Hospital, Caen, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Mouriaux
authors.affiliation: Department of Internal Medicine, Hospital, Caen, France.
authors.forename: Boris
authors.initials: B
authors.lastname: Bienvenu
authors.affiliation: Hospices Civils de Lyon, Pole IMER, Lyon, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Vicente
authors.affiliation: Hospices Civils de Lyon, Pole IMER, Lyon, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Bin
authors.affiliation: Department of Internal Medicine, Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France.
authors.forename: Christiane
authors.initials: C
authors.lastname: Broussolle
authors.affiliation: Hospices Civils de Lyon, Pole IMER, Lyon, France.
authors.forename: Evelyne
authors.initials: E
authors.lastname: Decullier
authors.affiliation: Department of Internal Medicine, Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Sève
mesh_terms: D003941:Diagnostic Techniques, Ophthalmological / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D064792:Pragmatic Clinical Trials as Topic; D011446:Prospective Studies; D014605:Uveitis / Q000175:diagnosis*; D014792:Visual Acuity