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Table 5 Screening algorithm for early detection of primary antibody deficiencies in a primary care setting

From: Development of a primary care screening algorithm for the early detection of patients at risk of primary antibody deficiency

Antibioticsa

ATC-code

Description

Score per prescription

J01AA02

Doxycycline

2

J01CA04

Amoxicillin

2

J01CF05

Flucloxacillin

1

J01CR02

Amoxicilline/clavulanic acid

2

J01EE01

Cotrimoxazole

2

J01FA01

Erythromycin

2

J01FA09

Clarithromycin

2

J01FA10

Azithromycin

2

J01MA02

Ciprofloxacin

1

J01MA12

Levofloxacin

2

J01MA14

Moxifloxacin

2

P01AB01

Metronidazole

1

J01CE05

Pheneticillin

2

J01CE02

Phenoxymethylpenicillin

2

J01DB01

Cefalexin

2

J01DC04

Cefaclor

2

J01DD14

Ceftibuten

2

J01DC02

Cefuroximaxetil

2

S02CA03

Hydrocortisone/colistin/bacitracin ear suspension

0.5

S02AA16

Ofloxacin ear suspension

0.5

ICPC code

Description

Score for presence of code

Respiratory tract infectionsb

 H01

Ear pain

1

 H04

Discharge from ear

1

 H71

Acute otitis media/myringitis

2

 H72

Otitis media with effusion

2

 H74

Chronic otitis media/other ear infections

1

 H74.01

Chronic otitis media

1

 H74.02

Mastoiditis

2

 R05

Coughing

1

 R07

Sneezing/nasal congestion/running nose

0.5

 R09

Symptoms/complaints sinuses

1

 R73

Furuncle/abscess nose

2

 R74

Acute upper respiratory tract infection

2

 R74.01

Common cold

1

 R96

Asthma

2

 R90

Hypertrophy/chronic infection tonsils/adenoid

2

 R72

Streptococcal pharyngitis/red spark

1

 R72.01

Streptococcal pharyngitis

1

 R72.02

Red spark

1

 R74.02

Acute pharyngitis

1

 R75

Acute/chronic rhinosinusitis

2

 R75.01

Acute rhinosinusitis

2

 R75.02

Chronic rhinosinusitis

2

 R76

Acute tonsillitis/peritonsillar abscess

2

 R76.01

Acute tonsillitis

2

 R76.02

Peritonsillar abscess

1

 R77

Acute laryngitis/tracheitis

2

 R77.01

Subglottic laryngitis/pseudo croup

1

 R77.02

Acute epiglottitis

1

 R78

Acute bronchitis/bronchiolitis

2

 R81

Pneumonia

3

 R91

Chronic bronchitis/bronchiectasis

1

 R91.01

Chronic bronchitis

1

 R91.02

Bronchiectasis

4

Gastro-intestinal complaintsc

 D11

Diarrhea

2

 D70

Infectious diarrhea, dysentery

1

 D70.01

Salmonella

1

 D70.02

Shigella-/Yersinia-/Campylobacter intestinal infection

2

 D70.03

Giardia

2

 D73

Presumed gastro-intestinal infection

2

 D86

Other peptic ulcer

1

 D93

Inflammatory bowel syndrome

1

 D94

Ulcerative colitis/chronic enteritis

1

 D94.01

Ulcerative colitis

1

Other infectionsd

 L70.01

Osteomyelitis

1

 L70.02

Septic arthritis

1

 N71

Meningitis/encephalitis

2

 N71.01

Bacterial meningitis

2

 N71.02

Viral meningitis

2

 N71.03

Encephalitis

2

 N71.04

Myelitis

2

Auto-immune symptomsd

 B04

Symptoms/complaints blood/blood forming organs

1

 B81

Pernicious/folic acid anemia

1

 B82

Other/non specified anemia

1

 B83

Purpura/coagulation disorder/aberrant thrombocytes

1

 B83.02

Idiopathic thrombocytopenic purpura (ITP)

2

 L88

Rheumatoid arthritis/related diseases

1

 L88.01

Rheumatoid arthritis

2

 R83.02

Sarcoidosis

1

 S23.01

Alopecia areata

1

 S99.04

Vitiligo

1

 T86

Hypothyroidism

1

 T99.02

Thyroiditis

1

 T99.12

Adrenal insufficiency

1

 D94.02

Crohn’s disease

2

 D99.06

Coeliac disease

1

 N99

Myasthenia gravis

1

Malignancies, lymphoproliferative- and other symptomsd

ICPC code

Description

Score

D74

Gastric cancer

1

B72

Hodgkin’s disease

1

B72.01

Hodgkin’s disease

1

B72.02

Non-Hodgkin lymphoma

2

T08

Weight loss

1

B87

Splenomegaly

2

B02

Lymphadenopathy

1

D96

Hepatomegaly

1

T10

Failure to thrive

2

A04

Fatigue/weakness

1

B84

Aberrant leukocytes

0.5

N94

Other peripheral neuritis/neuropathy

1

Laboratory valuese

Laboratory measure

Aberrant value (g/L)

Score if aberrant value present

IgG-total

< 7

8

IgG1

< 4.9

8

IgG2

< 1.5

8

IgG3

< 0.2

8

IgG4

< 0.08

8

IgM-total

< 0.4

8

IgA-total

< 0.7

4

Calculated globulin (total protein − albumin)

< 18

6

Visits to general practitionerf

Description

Cut-off value

Score if visits ≥ cut-off value

Visits to the general practitioner clinic in the year before the censoring date

≥ 6 visits

3

Ambiguous codesg

ICPC code

Description

 

B72

Hodgkin’s lymphoma

 

B72.01

Hodgkin’s lymphoma

 

B72.02

Non-Hodgkin lymphoma

 

A87.02

Post-transplantation

 

D74

Gastric cancer

 

D74

Colon or rectal cancer

 

Exclusion criteria

ICPC code/other

Description

 

B73

Leukemia

 

B74.01

Multiple myeloma

 

B90

HIV-infection

 

B90.01

HIV seropositive without symptoms

 

B90.02

AIDS/AIDS-related complex

 

P15.01

Alcoholism

 

P15.02

Delirium tremens

 

P15.03

Wernicke–Korsakoff

 

P19.03

Addiction to hard drugs

 

T06

Anorexia nervosa/bulimia

 

T06.01

Anorexia nervosa

 

T06.02

Bulimia

 

T99.01

Immunodeficiency

 

T99.10

Cystic fibrosis

 

Age

< 12 years or > 70 years

 
  1. AIDS acquired immune deficiency syndrome, ATC anatomic therapeutic chemical, EHR electronic health record, HIV human immunodeficiency virus, ICPC International Classification of Primary Care, Ig immunoglobulin
  2. aTotal score in the 4 years before the censoring date is calculated. If a patient is enrolled in the GP clinic less than 4 years, this is corrected for with the formula: (total number of prescriptions * 4)/(number of days enrolled/365). Prescriptions before the age of 6 years are not taken into account
  3. bScore is attributed if the ICPC code is registered in the 10 years before the censoring date
  4. cScore is attributed if the ICPC code is registered in the 10 years before the censoring date. Auto-immune symptoms are registered below
  5. dScore is attributed if the ICPC code is registered in the EHR at any time-point before the censoring date
  6. eScore is attributed if a reduced lab value is registered in the EHR at any time-point before the censoring date
  7. fBoth physical and electronic visits are taken into account
  8. gFor these codes, EHRs were screened up to the moment of the ambiguous diagnosis
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Allergy, Asthma & Clinical Immunology

ISSN: 1710-1492

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