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.

DESIGN: Prospective observational cohort study.

SETTING: Urban pediatric emergency department.

PARTICIPANTS: 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.

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

MAIN OUTCOME MEASURES: 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.

CONCLUSION: 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.