COMPARISON OF THE VON-REYN AND DUKE CRITERIA FOR THE DIAGNOSIS OF INFECTIVE ENDOCARDITIS - A CRITICAL ANALYSIS OF 161 EPISODES

The newly proposed diagnostic criteria for infective endocarditis (Duk e criteria) were evaluated in 161 consecutive episodes treated for sus pected infective endocarditis (IE) at one institution over a 5-year pe riod. A significantly higher proportion of episodes were diagnosed as definite endocarditis by the new Duke criteria compared with a diagnos is as definite or probable endocarditis by the older von Reyn criteria (68% vs 56%; p < 0.05). If all 161 episodes were to be reclassified, excluding pathological data, which are seldom available at the start o f treatment, the Duke criteria classified significantly more episodes as 'definite' compared with the analogous category 'probable' endocard itis by the von Reyn criteria (60% vs 44%; p < 0.01), Forty-four patho logically proven episodes were reclassified in the same way, and 73% o f these episodes were classified as 'definite' IE by the Duke criteria compared to 55% classified as 'probable' IE using the von Reyn criter ia. In 33 (20%) episodes no heart murmur could be detected on admissio n and the Duke criteria provided an initial diagnosis of 'definite' IE in 58% of these episodes compared with only 6% classified as 'definit e' or 'probable' IE by the von Reyn criteria (p < 0.0001), The newly p roposed Duke criteria are an improvement on the older von Reyn criteri a in the clinical diagnosis of IE, especially in initial phase of trea tment. However, the sensitivity when establishing a correct clinical d iagnosis of 'definite' IE for the pathologically proven cases was only 73%. The category of 'possible' IE by the Duke criteria is confusing, since it does not sag anything of the likelihood on an actual IE; the only objective fact is that no alternative diagnosis has been proven.