Clinical meaning
Diagnostic criteria fulfillment is the systematic process of evaluating clinical findings against established diagnostic standards (DSM-5 for psychiatric disorders, ACR/EULAR for rheumatologic conditions, Jones criteria for rheumatic fever, Duke criteria for endocarditis, etc.). Evidence-based criteria typically include major and minor criteria, with specified combinations required for diagnosis. Sensitivity-oriented criteria cast a wider net (fewer missed cases, more false positives); specificity-oriented criteria are more restrictive (fewer false positives, may miss atypical presentations). The NP must understand which criteria apply, how to apply them correctly, and when clinical judgment should override strict criteria adherence (criteria are guides, not absolute rules -- atypical presentations may not meet criteria but still warrant treatment).
Diagnosis & workup
Diagnostics & workup: - Rheumatic fever (revised Jones criteria): requires evidence of preceding GAS infection PLUS 2 major or 1 major + 2 minor criteria; Major: carditis, migratory polyarthritis, Sydenham chorea, erythema marginatum, subcutaneous nodules; Minor: fever, polyarthralgia, elevated ESR/CRP, prolonged PR interval - Infective endocarditis (modified Duke criteria): 2 major, or 1 major + 3 minor, or 5 minor; Major: positive blood cultures (typical organisms in ≥2 cultures), endocardial involvement on echo (vegetation, abscess, dehiscence); Minor: predisposing condition, fever, vascular phenomena, immunologic phenomena, microbiologic evidence not meeting major - SLE (ACR/EULAR 2019): entry criterion ANA ≥1:80; then additive weighted criteria across 7 clinical domains (constitutional, hematologic, neuropsychiatric, mucocutaneous, serosal, musculoskeletal, renal) and 3 immunology domains (anti-dsDNA, anti-Sm, complement, antiphospholipid); score ≥10 = SLE - Sepsis (Sepsis-3): suspected infection + SOFA score increase ≥2 points (qSOFA for bedside screening: altered mental status, SBP ≤100, RR ≥22 -- 2 of 3 = high risk) - SIRS criteria (older): ≥2 of: temp >38°C or <36°C, HR >90, RR >20 or PaCO2 <32, WBC >12k or <4k or >10% bands