Prediction of bacteremia in the emergency department: an external validation of a clinical decision rule

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 -