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Medical Science Monitor Basic Research


eISSN: 1643-3750

A Simple Scoring System for Quick, Accurate, and Reliable Early Diagnosis of Hand, Foot, and Mouth Disease

Shaoxing Chen, Kaihong Yi, Xiaojun Chen, Liping Li, Xuerui Tan

Department of Community Monitoring, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China (mainland)

Med Sci Monit 2018; 24:8627-8638

DOI: 10.12659/MSM.911736

Available online:

Published: 2018-11-29


BACKGROUND: To construct an accurate, reliable, and simple scoring system of improving HFMD diagnosis.
MATERIAL AND METHODS: Based on the following 3 steps, a simple scoring diagnostic system was built: (1) we selected basic markers (age and sex), markers recommended in HFMD diagnosis guidelines, and significant biomarkers among severity groups found in a large dataset; (2) we used positive constituent ratio for determining scores of each marker; and (3) we applied receiving operating curve in an external dataset to determine the optimal cut-off score.
RESULTS: The selected markers were sex, age, fever, skin rashes, nervous system disorder, respiratory system disorder, digestive system disorder and cardiopulmonary complications, C-reactive-protein, White Blood Cell, Creatinine Kinase, Creatinine Kinase Isoenzyme, Gamma-Glutamyl Transpeptidase, Albumin, Globulin, Albumin/Globulin Ratio, Natrium, Chloride, Calcium, and Glucose. A simple scoring system with 3.9684 as the lower cut-off was constructed. The AUC was 0.918 (95% CI: 0.874-0.963, P<0.01). The sensitivity, specificity, and Youden Index, which were based on the validation dataset of 200 subjects (80 cases, 120 non-cases with skin rashes or fever), were 0.95, 0.90, and 0.85, respectively.
CONCLUSIONS: This simple scoring system is an effective method to diagnose HFMD.

Keywords: Epidemiologic Study Characteristics as Topic, Hand, Foot and Mouth Disease, Research Design