TY - JOUR
T1 - Prediction of bacteremia in the emergency department
T2 - an external validation of a clinical decision rule
AU - Jessen, Marie K
AU - Mackenhauer, Julie
AU - Hvass, Anne Mette S W
AU - Ellermann-Eriksen, Svend
AU - Skibsted, Simon
AU - Kirkegaard, Hans
AU - Schønheyder, Henrik C
AU - Shapiro, Nathan I
AU - CONSIDER Sepsis Network
PY - 2016/2
Y1 - 2016/2
N2 - OBJECTIVE: The objective of this study was to validate a previously published clinical decision rule for predicting a positive blood culture in emergency department (ED) patients with suspected infection on the basis of major and minor criteria and a total score (Shapiro et al., J Emerg Med, 2008; 35:255-264).METHODS: This is a retrospective matched cohort study of adult ED patients with blood cultures obtained from 1 January 2011 through to 31 December 2011. ED patients with blood culture-confirmed bacteremia were matched 1 : 3 with patients with negative cultures. The outcome was 'true bacteremia'. Data on clinical history, comorbid illnesses, physical observations, and laboratory tests were used to evaluate the application of the clinical decision rule. We report the sensitivity, specificity, and area under the curve.RESULTS: Among 1526 patients, 105 (6.9%) patients were classified with true bacteremia. The sensitivity of the prediction rule was 94% (95% confidence interval, 88-98%) and the specificity was 48% (95% confidence interval, 42-53%). The area under the receiver-operating characteristics curve was 0.83.CONCLUSION: The clinical decision rule performed well in our ED setting and is likely to be a useful supplement to clinical judgment.
AB - OBJECTIVE: The objective of this study was to validate a previously published clinical decision rule for predicting a positive blood culture in emergency department (ED) patients with suspected infection on the basis of major and minor criteria and a total score (Shapiro et al., J Emerg Med, 2008; 35:255-264).METHODS: This is a retrospective matched cohort study of adult ED patients with blood cultures obtained from 1 January 2011 through to 31 December 2011. ED patients with blood culture-confirmed bacteremia were matched 1 : 3 with patients with negative cultures. The outcome was 'true bacteremia'. Data on clinical history, comorbid illnesses, physical observations, and laboratory tests were used to evaluate the application of the clinical decision rule. We report the sensitivity, specificity, and area under the curve.RESULTS: Among 1526 patients, 105 (6.9%) patients were classified with true bacteremia. The sensitivity of the prediction rule was 94% (95% confidence interval, 88-98%) and the specificity was 48% (95% confidence interval, 42-53%). The area under the receiver-operating characteristics curve was 0.83.CONCLUSION: The clinical decision rule performed well in our ED setting and is likely to be a useful supplement to clinical judgment.
KW - Adult
KW - Aged
KW - Bacteremia/blood
KW - Blood/microbiology
KW - Blood-Borne Pathogens/isolation & purification
KW - Case-Control Studies
KW - Chi-Square Distribution
KW - Databases, Factual
KW - Decision Support Systems, Clinical
KW - Denmark
KW - Emergency Service, Hospital
KW - Female
KW - Hospitals, University
KW - Humans
KW - Male
KW - Middle Aged
KW - Outcome Assessment, Health Care
KW - Predictive Value of Tests
KW - ROC Curve
KW - Retrospective Studies
KW - Statistics, Nonparametric
U2 - 10.1097/MEJ.0000000000000203
DO - 10.1097/MEJ.0000000000000203
M3 - Journal article
C2 - 25222426
SN - 0969-9546
VL - 23
SP - 44
EP - 49
JO - European journal of emergency medicine : official journal of the European Society for Emergency Medicine
JF - European journal of emergency medicine : official journal of the European Society for Emergency Medicine
IS - 1
ER -