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Editor,—We read with interest the paper by Dr Hardie and colleagues.1 We all agree now on the non-specificity of the case definition and on the heterogeneous nature of Reye’s syndrome.2–4 Updated Reye’s syndrome is not a specific clinicopathological entity, but a descriptive term used to designate the condition of a child presenting with an unexplained non-inflammatory encephalopathy and signs of liver dysfunction (international workshop ‘Reye’s syndrome revisited’, Leuven, 3 May 1996).
However, as there is a wide spectrum of differential diagnoses in patients meeting the diagnostic criteria,5 classifying them now in two groups, the ‘Reye group’ and the ‘Reye-like inherited metabolic disease group’ is inaccurate: the Reye group again is heterogeneous, composed of patients with infections (and fever), and of patients with toxic and other diseases. This classification again enhances the risk of epidemiological biases1–3.
Whether the scoring system devised by the authors is a valid predictor of ‘Reye’ (high score) versus ‘Reye-like’ (low score) has to be challenged as well. This scoring system does include exclusion criteria for Reye’s syndrome (for example a patient with positive cerebrospinal fluid can still be diagnosed as having …