Objective. To compare the sensitivity of 3 different criteria—von Reyn, Duke, and modified Duke—in diagnosing infective endocarditis (IE) in children.Study Design. Retrospective case study in a tertiary pediatric hospital.Methods and Results. Between 1985 and 2001, 41 episodes of IE were documented in 40 children (median: 7 years old; range: 1 week to 18 years). The diagnosis was based on echocardiographic and microbiologic or pathologic findings. The initial echocardiogram suggested IE in 95% of the cases. Main findings were vegetations in 36, perivalvular abscess in 4, and/or new valvular leaks in 6 cases. In 31 (76%) of the 41 episodes, the causative organisms were identified directly by specimen bacteriology or blood cultures (BCs) or indirectly by polymerase chain reaction or serology. Sensitivities of the von Reyn, Duke, and modified Duke criteria in diagnosing IE were 63%, 81%, and 88%, respectively. In 10 cases (22%), the diagnosis of IE was “rejected” by the von Reyn criteria but was “definite or possible” by the Duke and modified Duke criteria. In 3 cases, the diagnosis of IE was “possible” by the Duke but “definite” by the modified Duke criteria: 2 of the 3 cases had 1 major and ≥3 minor symptoms, and 1 had Q fever. Five episodes (12%) were classified as “possible” IE by the modified Duke criteria: although major findings were present on echocardiography, no organism was identified on repeat BCs. Positive BC was the only criterion that differentiated “definite” from “possible” IE.Conclusions. The modified Duke classification was more sensitive in diagnosing IE in children than the von Reyn and Duke criteria. Still, 12% failed to be classified as “definite” IE by the modified Duke criteria. This illustrates the importance of positive BCs as a major IE criterion while significant echocardiographic findings are less considered by the presently used criteria.
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机译：目的。为了比较3种不同标准（冯·雷恩，杜克大学和改良的杜克大学）在诊断儿童感染性心内膜炎（IE）中的敏感性。研究设计。一家三级儿科医院的回顾性案例研究。方法与结果。在1985年至2001年之间，有40名儿童（中位数：7岁;范围：1周至18岁）被记录为IE发作41次。诊断基于超声心动图和微生物学或病理学发现。最初的超声心动图显示IE占95％。主要发现是36例植被，4例周壁脓肿和/或6例新瓣膜渗漏。在41次发作中的31次（76％）中，病原微生物直接通过标本细菌学或血液培养（BCs）鉴定，或通过聚合酶链反应或血清学间接鉴定。 von Reyn，Duke和修改后的Duke标准在诊断IE中的敏感性分别为63％，81％和88％。在10例（22％）中，冯·雷恩标准“拒绝”了IE的诊断，但杜克大学和经过修改的杜克标准对IE的诊断“确定或可能”。在3例中，杜克大学对IE的诊断是“可能的”，而经修订的杜克标准是“肯定的”：3例中的2例具有1个主要症状和≥3个轻微症状，其中1例有Q发烧。修改后的Duke标准将5次发作（12％）归类为“可能” IE：尽管在超声心动图上发现了主要发现，但在重复BC上未发现任何生物。 BC阳性是区分“确定的”和“可能的” IE的唯一标准。改良的Duke分类法对儿童IE的诊断比von Reyn和Duke标准更敏感。尽管如此，根据修改后的Duke标准，仍没有12％的人被归类为“确定的” IE。这说明了阳性BC作为重要的IE标准的重要性，而目前使用的标准很少考虑显着的超声心动图检查结果。
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