NEW YORK (Reuters Health) – Physicians' ability to distinguish whether febrile patients with respiratory tract infections (RTI) may have an ailment due to viruses or bacteria is decidedly low, according to Israeli researchers.
Reporting in the December issue of the British Journal of General Practice, Dr. David Lieberman, of Soroka Medical Center, Beer-Sheva, and colleagues, note that in patients with RTI, the infectious etiology has "immediate therapeutic ramifications, and the physician must reach a decision on this question immediately after taking a history and examining the patient."
To determine how accurate such decisions might be, the researchers conducted a prospective study in which 15 board-certified family medical specialists examined and interviewed a total of 250 patients. All had a febrile illness of less than a week's duration and also had cough, coryza, sore throat, or hoarseness.
The physicians decided whether the etiological agent was viral or "bacterial/atypical" and these findings were compared with those of serological tests of blood drawn at the time of the examination and 3 to 4 weeks later.
Testing revealed at least one etiological agent in 167 patients. Physicians judged that viruses were the underlying cause in 77 patients. Serological testing confirmed that in 46 of these cases. Similarly, they deemed that 90 infections had a bacterial/atypical etiology, but were correct in only 45 of these cases, based on serological testing.
Physicians' judgment for a bacterial/atypical etiology "had a negative predictive value of only 60% and a positive predictive value of only 50%," the researchers calculate. They conclude that the ability to assess whether the infectious etiology of RTI is "viral or bacterial/atypical is low and is no more reliable than tossing a coin."
Br J Gen Pract 2001;51:999-1000.
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