Identifying Patients with Bacteremia in Community-Hospital Emergency Rooms: A Retrospective Cohort Study.
OBJECTIVES:(1) To develop a clinical prediction rule to identify patients with bacteremia, using only information that is readily available in the emergency room (ER) of community hospitals, and (2) to test the validity of that rule with a separate, independent set of data. DESIGN:Multicenter retros...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2016-01-01
|
| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC4811592?pdf=render |
| _version_ | 1818549568571179008 |
|---|---|
| author | Taro Takeshima Yosuke Yamamoto Yoshinori Noguchi Nobuyuki Maki Koichiro Gibo Yukio Tsugihashi Asako Doi Shingo Fukuma Shin Yamazaki Eiji Kajii Shunichi Fukuhara |
| author_facet | Taro Takeshima Yosuke Yamamoto Yoshinori Noguchi Nobuyuki Maki Koichiro Gibo Yukio Tsugihashi Asako Doi Shingo Fukuma Shin Yamazaki Eiji Kajii Shunichi Fukuhara |
| author_sort | Taro Takeshima |
| collection | DOAJ |
| description | OBJECTIVES:(1) To develop a clinical prediction rule to identify patients with bacteremia, using only information that is readily available in the emergency room (ER) of community hospitals, and (2) to test the validity of that rule with a separate, independent set of data. DESIGN:Multicenter retrospective cohort study. SETTING:To derive the clinical prediction rule we used data from 3 community hospitals in Japan (derivation). We tested the rule using data from one other community hospital (validation), which was not among the three "derivation" hospitals. PARTICIPANTS:Adults (age ≥ 16 years old) who had undergone blood-culture testing while in the ER between April 2011 and March 2012. For the derivation data, n = 1515 (randomly sampled from 7026 patients), and for the validation data n = 467 (from 823 patients). ANALYSIS:We analyzed 28 candidate predictors of bacteremia, including demographic data, signs and symptoms, comorbid conditions, and basic laboratory data. Chi-square tests and multiple logistic regression were used to derive an integer risk score (the "ID-BactER" score). Sensitivity, specificity, likelihood ratios, and the area under the receiver operating characteristic curve (i.e., the AUC) were computed. RESULTS:There were 241 cases of bacteremia in the derivation data. Eleven candidate predictors were used in the ID-BactER score: age, chills, vomiting, mental status, temperature, systolic blood pressure, abdominal sign, white blood-cell count, platelets, blood urea nitrogen, and C-reactive protein. The AUCs was 0.80 (derivation) and 0.74 (validation). For ID-BactER scores ≥ 2, the sensitivities for derivation and validation data were 98% and 97%, and specificities were 20% and 14%, respectively. CONCLUSIONS:The ID-BactER score can be computed from information that is readily available in the ERs of community hospitals. Future studies should focus on developing a score with a higher specificity while maintaining the desired sensitivity. |
| first_indexed | 2024-12-12T08:35:03Z |
| format | Article |
| id | doaj.art-5fe80126de544b41af5279c9e99993f2 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-12T08:35:03Z |
| publishDate | 2016-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-5fe80126de544b41af5279c9e99993f22022-12-22T00:30:58ZengPublic Library of Science (PLoS)PLoS ONE1932-62032016-01-01113e014807810.1371/journal.pone.0148078Identifying Patients with Bacteremia in Community-Hospital Emergency Rooms: A Retrospective Cohort Study.Taro TakeshimaYosuke YamamotoYoshinori NoguchiNobuyuki MakiKoichiro GiboYukio TsugihashiAsako DoiShingo FukumaShin YamazakiEiji KajiiShunichi FukuharaOBJECTIVES:(1) To develop a clinical prediction rule to identify patients with bacteremia, using only information that is readily available in the emergency room (ER) of community hospitals, and (2) to test the validity of that rule with a separate, independent set of data. DESIGN:Multicenter retrospective cohort study. SETTING:To derive the clinical prediction rule we used data from 3 community hospitals in Japan (derivation). We tested the rule using data from one other community hospital (validation), which was not among the three "derivation" hospitals. PARTICIPANTS:Adults (age ≥ 16 years old) who had undergone blood-culture testing while in the ER between April 2011 and March 2012. For the derivation data, n = 1515 (randomly sampled from 7026 patients), and for the validation data n = 467 (from 823 patients). ANALYSIS:We analyzed 28 candidate predictors of bacteremia, including demographic data, signs and symptoms, comorbid conditions, and basic laboratory data. Chi-square tests and multiple logistic regression were used to derive an integer risk score (the "ID-BactER" score). Sensitivity, specificity, likelihood ratios, and the area under the receiver operating characteristic curve (i.e., the AUC) were computed. RESULTS:There were 241 cases of bacteremia in the derivation data. Eleven candidate predictors were used in the ID-BactER score: age, chills, vomiting, mental status, temperature, systolic blood pressure, abdominal sign, white blood-cell count, platelets, blood urea nitrogen, and C-reactive protein. The AUCs was 0.80 (derivation) and 0.74 (validation). For ID-BactER scores ≥ 2, the sensitivities for derivation and validation data were 98% and 97%, and specificities were 20% and 14%, respectively. CONCLUSIONS:The ID-BactER score can be computed from information that is readily available in the ERs of community hospitals. Future studies should focus on developing a score with a higher specificity while maintaining the desired sensitivity.http://europepmc.org/articles/PMC4811592?pdf=render |
| spellingShingle | Taro Takeshima Yosuke Yamamoto Yoshinori Noguchi Nobuyuki Maki Koichiro Gibo Yukio Tsugihashi Asako Doi Shingo Fukuma Shin Yamazaki Eiji Kajii Shunichi Fukuhara Identifying Patients with Bacteremia in Community-Hospital Emergency Rooms: A Retrospective Cohort Study. PLoS ONE |
| title | Identifying Patients with Bacteremia in Community-Hospital Emergency Rooms: A Retrospective Cohort Study. |
| title_full | Identifying Patients with Bacteremia in Community-Hospital Emergency Rooms: A Retrospective Cohort Study. |
| title_fullStr | Identifying Patients with Bacteremia in Community-Hospital Emergency Rooms: A Retrospective Cohort Study. |
| title_full_unstemmed | Identifying Patients with Bacteremia in Community-Hospital Emergency Rooms: A Retrospective Cohort Study. |
| title_short | Identifying Patients with Bacteremia in Community-Hospital Emergency Rooms: A Retrospective Cohort Study. |
| title_sort | identifying patients with bacteremia in community hospital emergency rooms a retrospective cohort study |
| url | http://europepmc.org/articles/PMC4811592?pdf=render |
| work_keys_str_mv | AT tarotakeshima identifyingpatientswithbacteremiaincommunityhospitalemergencyroomsaretrospectivecohortstudy AT yosukeyamamoto identifyingpatientswithbacteremiaincommunityhospitalemergencyroomsaretrospectivecohortstudy AT yoshinorinoguchi identifyingpatientswithbacteremiaincommunityhospitalemergencyroomsaretrospectivecohortstudy AT nobuyukimaki identifyingpatientswithbacteremiaincommunityhospitalemergencyroomsaretrospectivecohortstudy AT koichirogibo identifyingpatientswithbacteremiaincommunityhospitalemergencyroomsaretrospectivecohortstudy AT yukiotsugihashi identifyingpatientswithbacteremiaincommunityhospitalemergencyroomsaretrospectivecohortstudy AT asakodoi identifyingpatientswithbacteremiaincommunityhospitalemergencyroomsaretrospectivecohortstudy AT shingofukuma identifyingpatientswithbacteremiaincommunityhospitalemergencyroomsaretrospectivecohortstudy AT shinyamazaki identifyingpatientswithbacteremiaincommunityhospitalemergencyroomsaretrospectivecohortstudy AT eijikajii identifyingpatientswithbacteremiaincommunityhospitalemergencyroomsaretrospectivecohortstudy AT shunichifukuhara identifyingpatientswithbacteremiaincommunityhospitalemergencyroomsaretrospectivecohortstudy |