Comment on Fox et al's presentation of two invasive group A streptococcal (GAS) infections.
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Biomedical subjects
Publications and source records attributed to Zuber D Mulla.
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OBJECTIVE: To determine the clinical epidemiology of invasive group A streptococcal disease (IGASD) and identify predictors of admissions into an intensive care unit (ICU). DESIGN: A cross-sectional study. SETTING: Retrospective review of data. PATIENTS: A total of 204 patients hospitalized throughout the state of Florida, United States, between August 1996 and August 2000 for IGASD. INTERVENTION: None. MEASUREMENTS AND RESULTS: Prevalence odds ratios for ICU admissions were calculated for several demographic and clinical variables. The prevalence of ICU admissions was lower among patients 69 years of age or older compared to younger patients (odds ratio=0.43, 90% confidence interval: 0.23-0.83). The odds ratio associated with the presence of necrotizing fasciitis was 6.98 (90% confidence interval: 3.13-15.58). CONCLUSION: In this analysis of patients hospitalized for IGASD, the presence of necrotizing fasciitis was the strongest factor associated with admissions into an ICU.
The reliability of clinical methods is often taken for granted. There is considerable evidence, however, that variability of clinical measurements, interpretations, and judgements are greater than commonly thought. Inconsistency of clinical methods has profound and widespread implications in clinical practice. The inferential capacity of measurements depends on accuracy and reproducibility. Appropriate medical decisions cannot be reached without accurate and reliable data. This review will examine the conceptual relationship of reliability, accuracy, and validity. The role of observer reliability in ophthalmic test measurements and interpretations will be addressed in the context of three case reports.