Bacteremia Prediction With Prognostic Scores and a Causal Probabilistic Network - A Cohort Study of Emergency Department Patients

Klaus N. Jeppesen; Michael L. Dalsgaard; Stig H. Ovesen; Mette T. Rønsbo; Hans Kirkegaard; Marie K. Jessen

doi:10.1016/j.jemermed.2022.09.009

Bacteremia Prediction With Prognostic Scores and a Causal Probabilistic Network - A Cohort Study of Emergency Department Patients

Klaus N. Jeppesen, Michael L. Dalsgaard^*, Stig H. Ovesen, Mette T. Rønsbo, Hans Kirkegaard, Marie K. Jessen

^*Corresponding author for this work

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Abstract

Background: Physicians tend to overestimate patients’ pretest probability of having bacteremia. The low yield of blood cultures and contaminants is associated with significant financial cost, as well as increased length of stay and unnecessary antibiotic treatment. Objective: This study examined the abilities of the National Early Warning Score (NEWS), the Quick Sequential Organ Failure Assessment (qSOFA), the Modified Sequential Organ Failure Assessment (mSOFA), and two versions of the causal probabilistic network, SepsisFinder™ (SF) to predict bacteremia in adult emergency department (ED) patients. Methods: This cohort study included adult ED patients from a large urban, academic tertiary hospital, with blood cultures obtained within 24 h of admission between 2016 and 2017. The outcome measure was true bacteremia. NEWS, qSOFA, mSOFA, and the two versions of SF score were calculated for all patients based on the first available full set of vital signs within 2 h and laboratory values within 6 h after drawing the blood cultures. Area under the receiver operating characteristic curve (AUROC) was calculated for each scoring system. Results: The study included 3106 ED patients, of which 199 (6.4%) patients had true bacteremia. The AUROCs for prediction of bacteremia were: NEWS = 0.65, qSOFA = 0.60, SF I = 0.65, mSOFA = 0.71, and SF II = 0.80. Conclusions: Scoring systems using only vital signs, NEWS, and SF I showed moderate abilities in predicting bacteremia, whereas qSOFA performed poorly. Scoring systems using both vital signs and laboratory values, mSOFA and especially SF II, showed good abilities in predicting bacteremia.

Original language	English
Journal	Journal of Emergency Medicine
Volume	63
Issue	6
Pages (from-to)	738-746
Number of pages	9
ISSN	0736-4679
DOIs	https://doi.org/10.1016/j.jemermed.2022.09.009
Publication status	Published - Dec 2022

Keywords

bacteremia
clinical decision rules
emergency medicine
mSOFA
NEWS
qSOFA
SepsisFinder

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Bacteremia Prediction With Prognostic Scores and a Causal Probabilistic Network - A Cohort Study of Emergency Department PatientsFinal published version, 702 KBLicence: CC BY

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@article{e25e70f7bd354d03b8d4e9511f762991,

title = "Bacteremia Prediction With Prognostic Scores and a Causal Probabilistic Network - A Cohort Study of Emergency Department Patients",

abstract = "Background: Physicians tend to overestimate patients{\textquoteright} pretest probability of having bacteremia. The low yield of blood cultures and contaminants is associated with significant financial cost, as well as increased length of stay and unnecessary antibiotic treatment. Objective: This study examined the abilities of the National Early Warning Score (NEWS), the Quick Sequential Organ Failure Assessment (qSOFA), the Modified Sequential Organ Failure Assessment (mSOFA), and two versions of the causal probabilistic network, SepsisFinder{\texttrademark} (SF) to predict bacteremia in adult emergency department (ED) patients. Methods: This cohort study included adult ED patients from a large urban, academic tertiary hospital, with blood cultures obtained within 24 h of admission between 2016 and 2017. The outcome measure was true bacteremia. NEWS, qSOFA, mSOFA, and the two versions of SF score were calculated for all patients based on the first available full set of vital signs within 2 h and laboratory values within 6 h after drawing the blood cultures. Area under the receiver operating characteristic curve (AUROC) was calculated for each scoring system. Results: The study included 3106 ED patients, of which 199 (6.4%) patients had true bacteremia. The AUROCs for prediction of bacteremia were: NEWS = 0.65, qSOFA = 0.60, SF I = 0.65, mSOFA = 0.71, and SF II = 0.80. Conclusions: Scoring systems using only vital signs, NEWS, and SF I showed moderate abilities in predicting bacteremia, whereas qSOFA performed poorly. Scoring systems using both vital signs and laboratory values, mSOFA and especially SF II, showed good abilities in predicting bacteremia.",

keywords = "bacteremia, clinical decision rules, emergency medicine, mSOFA, NEWS, qSOFA, SepsisFinder",

author = "Jeppesen, {Klaus N.} and Dalsgaard, {Michael L.} and Ovesen, {Stig H.} and R{\o}nsbo, {Mette T.} and Hans Kirkegaard and Jessen, {Marie K.}",

note = "Publisher Copyright: {\textcopyright} 2022 The Authors",

year = "2022",

month = dec,

doi = "10.1016/j.jemermed.2022.09.009",

language = "English",

volume = "63",

pages = "738--746",

journal = "Journal of Emergency Medicine",

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Bacteremia Prediction With Prognostic Scores and a Causal Probabilistic Network - A Cohort Study of Emergency Department Patients. / Jeppesen, Klaus N.; Dalsgaard, Michael L.; Ovesen, Stig H. et al.
In: Journal of Emergency Medicine, Vol. 63, No. 6, 12.2022, p. 738-746.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Bacteremia Prediction With Prognostic Scores and a Causal Probabilistic Network - A Cohort Study of Emergency Department Patients

AU - Jeppesen, Klaus N.

AU - Dalsgaard, Michael L.

AU - Ovesen, Stig H.

AU - Rønsbo, Mette T.

AU - Kirkegaard, Hans

AU - Jessen, Marie K.

PY - 2022/12

Y1 - 2022/12

N2 - Background: Physicians tend to overestimate patients’ pretest probability of having bacteremia. The low yield of blood cultures and contaminants is associated with significant financial cost, as well as increased length of stay and unnecessary antibiotic treatment. Objective: This study examined the abilities of the National Early Warning Score (NEWS), the Quick Sequential Organ Failure Assessment (qSOFA), the Modified Sequential Organ Failure Assessment (mSOFA), and two versions of the causal probabilistic network, SepsisFinder™ (SF) to predict bacteremia in adult emergency department (ED) patients. Methods: This cohort study included adult ED patients from a large urban, academic tertiary hospital, with blood cultures obtained within 24 h of admission between 2016 and 2017. The outcome measure was true bacteremia. NEWS, qSOFA, mSOFA, and the two versions of SF score were calculated for all patients based on the first available full set of vital signs within 2 h and laboratory values within 6 h after drawing the blood cultures. Area under the receiver operating characteristic curve (AUROC) was calculated for each scoring system. Results: The study included 3106 ED patients, of which 199 (6.4%) patients had true bacteremia. The AUROCs for prediction of bacteremia were: NEWS = 0.65, qSOFA = 0.60, SF I = 0.65, mSOFA = 0.71, and SF II = 0.80. Conclusions: Scoring systems using only vital signs, NEWS, and SF I showed moderate abilities in predicting bacteremia, whereas qSOFA performed poorly. Scoring systems using both vital signs and laboratory values, mSOFA and especially SF II, showed good abilities in predicting bacteremia.

AB - Background: Physicians tend to overestimate patients’ pretest probability of having bacteremia. The low yield of blood cultures and contaminants is associated with significant financial cost, as well as increased length of stay and unnecessary antibiotic treatment. Objective: This study examined the abilities of the National Early Warning Score (NEWS), the Quick Sequential Organ Failure Assessment (qSOFA), the Modified Sequential Organ Failure Assessment (mSOFA), and two versions of the causal probabilistic network, SepsisFinder™ (SF) to predict bacteremia in adult emergency department (ED) patients. Methods: This cohort study included adult ED patients from a large urban, academic tertiary hospital, with blood cultures obtained within 24 h of admission between 2016 and 2017. The outcome measure was true bacteremia. NEWS, qSOFA, mSOFA, and the two versions of SF score were calculated for all patients based on the first available full set of vital signs within 2 h and laboratory values within 6 h after drawing the blood cultures. Area under the receiver operating characteristic curve (AUROC) was calculated for each scoring system. Results: The study included 3106 ED patients, of which 199 (6.4%) patients had true bacteremia. The AUROCs for prediction of bacteremia were: NEWS = 0.65, qSOFA = 0.60, SF I = 0.65, mSOFA = 0.71, and SF II = 0.80. Conclusions: Scoring systems using only vital signs, NEWS, and SF I showed moderate abilities in predicting bacteremia, whereas qSOFA performed poorly. Scoring systems using both vital signs and laboratory values, mSOFA and especially SF II, showed good abilities in predicting bacteremia.

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KW - clinical decision rules

KW - emergency medicine

KW - mSOFA

KW - NEWS

KW - qSOFA

KW - SepsisFinder

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U2 - 10.1016/j.jemermed.2022.09.009

DO - 10.1016/j.jemermed.2022.09.009

M3 - Journal article

C2 - 36522812

AN - SCOPUS:85144210883

SN - 0736-4679

VL - 63

SP - 738

EP - 746

JO - Journal of Emergency Medicine

JF - Journal of Emergency Medicine

IS - 6

ER -

Bacteremia Prediction With Prognostic Scores and a Causal Probabilistic Network - A Cohort Study of Emergency Department Patients

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