Quick BSI Score to Identify Bloodstream Infection at the Emergency Department

Abstract Background: Bloodstream infection (BSI) is a common and urgent condition at the emergency department (ED). In order to diagnose BSI, the current guideline fails to mention the juncture at which blood cultures ought to be taken. The decision whether or not to obtain hemoculture is solely based upon clinical judgment and outcomes pertaining to inappropriately ordered blood culture. This study aimed to develop predictive bloodstream infection scoring at the ED employing only clinical factors presented on ED arrival.Methods: This study was conducted retrospectively at the ED, Khon Kaen University Hospital, Thailand. Inclusion criteria encompassed adult patients suspected of infection defined by blood culture collection presented at the ED with intravenous antibiotics initiated during ED visits. Independent positive predictors for positive blood culture were used to create the Quick Bloodstream Infection score (qBSI score) through logistic regression analysis.Results: A total of 169578 patients visited the ED during the study period. Of those, 12556 patients (7.40%) were suspected of infection. 8177 cases met the study criteria and were categorized according to positive blood culture results, i.e. bloodstream infection (741 patients; 9.06%). Probability of positive blood culture was calculated via aged over 55 years + moderate to severe CKD + solid organ tumor + (2 x liver disease) + (2 x history of fever with chills) + (2 x body temperature of over 38.3oC). A score of 1 or over rendered 92.98% sensitivity, 15.40% specificity, 9.87% positive predictive value, 95.66% negative predictive value, positive likelihood ratio of 1.10, and negative likelihood ratio of 0.46.Conclusions: The qBSI score may be a helpful tool to perform blood culture in patients at the ED suspected of infection. Employing this score may facilitate in the determining of those needing blood culture at the ED.

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Quick BSI Score to Identify Bloodstream Infection at the Emergency Department

10.21203/rs.3.rs-33769/v2 ◽

2020 ◽

Author(s):

Pariwat Phungoen ◽

Nunchalit Lerdprawat ◽

Kittisak Sawanyawisuth ◽

Verajit Chotmongkol ◽

Kamonwon Ienghong ◽

...

Keyword(s):

Emergency Department ◽

Blood Culture ◽

Negative Predictive Value ◽

Bloodstream Infection ◽

Positive Blood Culture ◽

Clinical Judgment ◽

Predictive Value ◽

University Hospital ◽

Solid Organ ◽

Current Guideline

Abstract Background Bloodstream infection (BSI) is a common and urgent condition at the emergency department (ED). In order to diagnose BSI, the current guideline fails to mention the juncture at which blood cultures ought to be taken. The decision whether or not to obtain hemoculture is solely based upon clinical judgment and outcomes pertaining to inappropriately ordered blood culture. This study aimed to develop predictive bloodstream infection scoring at the ED employing only clinical factors presented on ED arrival. Methods This study was conducted retrospectively at the ED, Khon Kaen University Hospital, Thailand. Inclusion criteria encompassed adult patients suspected of infection defined by blood culture collection presented at the ED with intravenous antibiotics initiated during ED visits. Independent positive predictors for positive blood culture were used to create the Quick Bloodstream Infection score (qBSI score) through logistic regression analysis. Results A total of 169578 patients visited the ED during the study period. Of those, 12556 patients (7.40%) were suspected of infection. 8177 cases met the study criteria and were categorized according to positive blood culture results, i.e. bloodstream infection (741 patients; 9.06%). Probability of positive blood culture was calculated via aged over 55 years + moderate to severe CKD + solid organ tumor + (2 x liver disease) + (2 x history of fever with chills) + (2 x body temperature of over 38.3 o C). A score of 1 or over rendered 92.98% sensitivity and negative predictive value of 95.65%. Conclusions The qBSI score presented effective sensitivity and negative predictive value amid positive blood culture in patients at the ED suspected of infection. Resultant of employing this score may facilitate in the determining of those exhibiting the need for blood culture at the ED.

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Quick BSI Score to Identify Bloodstream Infection at the Emergency Department

10.21203/rs.3.rs-33769/v1 ◽

2020 ◽

Author(s):

Pariwat Phungoen ◽

Nunchalit Lerdprawat ◽

Kittisak Sawanyawisuth ◽

Verajit Chotmongkol ◽

Kamonwon Ienghong ◽

...

Keyword(s):

Emergency Department ◽

Blood Culture ◽

Negative Predictive Value ◽

Bloodstream Infection ◽

Positive Blood Culture ◽

Clinical Judgment ◽

Predictive Value ◽

University Hospital ◽

Solid Organ ◽

Current Guideline

Abstract Background Bloodstream infection (BSI) is a common and urgent condition at the emergency department (ED). In order to diagnose BSI, the current guideline fails to mention the juncture at which blood cultures ought to be taken. The decision whether or not to obtain hemoculture is solely based upon clinical judgment and outcomes pertaining to inappropriately ordered blood culture. This study aimed to develop predictive bloodstream infection scoring at the ED employing only clinical factors presented on ED arrival. Methods This study was conducted retrospectively at the ED, Khon Kaen University Hospital, Thailand. Inclusion criteria encompassed adult patients suspected of infection defined by blood culture collection presented at the ED with intravenous antibiotics initiated during ED visits. Independent positive predictors for positive blood culture were used to create the Quick Bloodstream Infection score (qBSI score) through logistic regression analysis. Results A total of 169578 patients visited the ED during the study period. Of those, 12556 patients (7.40%) were suspected of infection. 8177 cases met the study criteria and were categorized according to positive blood culture results, i.e. bloodstream infection (741 patients; 9.06%). Probability of positive blood culture was calculated via aged over 55 years + moderate to severe CKD + solid organ tumor + (2 x liver disease) + (2 x history of fever with chills) + (2 x body temperature of over 38.3oC). A score of 1 or over rendered 92.98% sensitivity and negative predictive value of 95.65%. Conclusions The qBSI score presented effective sensitivity and negative predictive value amid positive blood culture in patients at the ED suspected of infection. Resultant of employing this score may facilitate in the determining of those exhibiting the need for blood culture at the ED.

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Clinical factors associated with bloodstream infection at the emergency department

BMC Emergency Medicine ◽

10.1186/s12873-021-00426-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Pariwat Phungoen ◽

Nunchalit Lerdprawat ◽

Kittisak Sawanyawisuth ◽

Verajit Chotmongkol ◽

Kamonwon Ienghong ◽

...

Keyword(s):

Emergency Department ◽

Blood Culture ◽

Bloodstream Infection ◽

Positive Blood Culture ◽

Clinical Judgment ◽

Solid Organ ◽

Clinical Factors ◽

Suspected Infection ◽

Intravenous Antibiotics ◽

History Of

Abstract Background Bloodstream infection (BSI) is a common urgent condition at the emergency department (ED). However, current guidelines for diagnosis do not specify the juncture at which blood cultures should be taken. The decision whether or not to obtain hemoculture is based solely upon clinical judgment and potential outcomes of inappropriately ordered cultures. This study aimed to find clinical factors present on ED arrival that are predictive of bloodstream infection. Methods This study was conducted retrospectively at the ED of a single tertiary care hospital in Thailand. We included adult patients with suspected infection based on blood culture who were treated with intravenous antibiotics during their ED visit. Independent positive predictors for positive blood culture were calculated by logistic regression analysis. Results A total of 169,578 patients visited the ED during the study period, 12,556 (7.40%) of whom were suspected of infection. Of those, 8177 met the study criteria and were categorized according to blood culture results (741 positive; 9.06%). Six clinical factors, including age over 55 years, moderate to severe CKD, solid organ tumor, liver disease, history of chills, and body temperature of over 38.3 °C, were associated with positive blood culture. Conclusions Clinical factors at ED arrival can be used as predictors of bloodstream infection.

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Diagnostic accuracy of septic markers for neonatal sepsis

Paediatrica Indonesiana ◽

10.14238/pi48.5.2008.299-305 ◽

2016 ◽

Vol 48 (5) ◽

pp. 299

Author(s):

Thermiany AS ◽

W Retayasa ◽

M Kardana ◽

IN Lila

Keyword(s):

Blood Culture ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Likelihood Ratio ◽

Neonatal Sepsis ◽

Predictive Value ◽

Gold Standard ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Suspected Sepsis

Background Neonatal sepsis is a major cause of morbidity andmortality. A positive blood culture is the gold standard fordiagnosis of neonatal sepsis. The signs and symptoms suggestingneonatal sepsis are non-specific. There is no rapid and reliablelaboratory test findings for confirmation of etiologic diagnosis.Clinical signs, symptoms, and laboratory examinations are notperceived as sensitive or specific for diagnosis of sepsis.Objective The purpose of this study was to evaluate the accuracyof the septic markers for diagnosis of neonatal sepsis.Methods Blood culture was used as gold standard to compareseptic markers to diagnose neonatal sepsis. Sensitivity, specificity,positive predictive value (PPV), negative predictive value (NPV),positive and negative likelihood ratio (LR), and accuracy werecalculated.Results We identified 130 cases suspected of neonatal sepsis duringSeptember 2005 until March 2006. Four patients were excludedbecause of major congenital anomalies. The mean age was 2.2 daysand 51.6% were boys. We found fifty six (44.4%) neonates havepositive blood culture. All of septic markers had sensitivity morethan 80%. Immature to Total Neutrophil ratio (Iff) ratio had thehighest sensitivity (96.4%) and C-Reactive Protein (CRP) had thelowest sensitivity (80.4o/o). Combination among leukocyte count,thrombocyte, and Iff ratio had the highest sensitivity (sensitivitywas 85. 7%, specificity was 97.1 o/o, positive predictive value was95.9%, negative predictive value was 89.5%, accuracy was 94.4%,and positive likelihood ratio was 30.0).Conclusion Septic markers can be used in the diagnosticevaluation of neonates with suspected sepsis.

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A hematologic scoring system and C-reactive protein compared to blood cultures for diagnosing bacterial neonatal sepsis

Paediatrica Indonesiana ◽

10.14238/pi57.2.2017.70-5 ◽

2017 ◽

Vol 57 (2) ◽

pp. 70

Author(s):

Deddy Eka Febri Liestiadi ◽

Emil Azlin ◽

Selvi Nafianti

Keyword(s):

Blood Culture ◽

Likelihood Ratio ◽

Neonatal Sepsis ◽

Predictive Value ◽

Scoring System ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Blood Cultures ◽

C Reactive Protein ◽

Reactive Protein

Background Neonatal sepsis is the leading cause of death after pneumonia. Definitive bacterial sepsis diagnoses are made by blood culture results, which require a lengthy time. C-reactive protein (CRP) levels and a hematologic scoring system by Rodwell et al. are rapid tests that may be useful for diagnosing neonatal sepsis. Objective To determine the diagnostic value of CRP measurement and a hematologic scoring system compared to blood culture as the gold standard for diagnosing neonatal sepsis. Methods A cross-sectional study was conducted from April to August 2015 in the Neonatology Ward of Haji Adam Malik Hospital, Medan. A total of 43 neonates who were clinically suspected to have sepsis underwent CRP, hematologic scoring, and blood cultures. The IT ratio and procalcitonin indices were also examined. Diagnostic values were analyzed by a 2x2 table.Results Fourteen percent from all sample had positive bacterial culture. The CRP measurements had a sensitivity of 92.8%, specificity of 62%, positive predictive value (PPV) of 54.1%, negative predictive value (NPV) of 94.7%, positive likelihood ratio (PLR) of 2.44, and negative likelihood ratio (NLR) of 0.11. The hematologic scoring system had a sensitivity of 100%, specificity of 82.7%, PPV of 73.6%, NPV of 100%, PLR of 5.78, and NLR of 0. Procalcitonin and IT ratio show a good value of sensitivity and NPV, respectively. Conclusion The hematologic scoring system has better specificity than CRP measurement as compared to blood culture. However, both tests have good sensitivity for diagnosing neonatal sepsis.

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Circulating tumour DNA methylation in hepatocellular carcinoma diagnosis using digital droplet PCR

Journal of International Medical Research ◽

10.1177/0300060521992962 ◽

2021 ◽

Vol 49 (3) ◽

pp. 030006052199296

Author(s):

Juan Wang ◽

Liu Yang ◽

Yanjun Diao ◽

Jiayun Liu ◽

Jinjie Li ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Dna Methylation ◽

Likelihood Ratio ◽

Predictive Value ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Control Group ◽

Control Subjects ◽

Droplet Pcr ◽

Healthy Control

Objective To evaluate the performance of a DNA methylation-based digital droplet polymerase chain reaction (ddPCR) assay to detect aberrant DNA methylation in cell-free DNA (cfDNA) and to determine its application in the detection of hepatocellular carcinoma (HCC). Methods The present study recruited patients with liver-related diseases and healthy control subjects. Blood samples were used for the extraction of cfDNA, which was then bisulfite converted and the extent of DNA methylation quantified using a ddPCR platform. Results A total of 97 patients with HCC, 80 healthy control subjects and 46 patients with chronic hepatitis B/C virus infection were enrolled in the study. The level of cfDNA in the HCC group was significantly higher than that in the healthy control group. For the detection of HCC, based on a cut-off value of 15.7% for the cfDNA methylation ratio, the sensitivity and specificity were 78.57% and 89.38%, respectively. The diagnostic accuracy was 85.27%, the positive predictive value was 81.91% and the negative predictive value was 87.20%. The positive likelihood ratio of 15.7% in HCC diagnosis was 7.40, while the negative likelihood ratio was 0.24. Conclusions A sensitive methylation-based assay might serve as a liquid biopsy test for diagnosing HCC.

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Misuse of ultrasound for palpable undescended testis by primary care providers: A prospective study

Canadian Urological Association Journal ◽

10.5489/cuaj.3242 ◽

2015 ◽

Vol 9 (11-12) ◽

pp. 387 ◽

Cited By ~ 3

Author(s):

Nathan C Wong ◽

Rahul K Bansal ◽

Armando J Lorenzo ◽

Jorge DeMaria ◽

Luis H Braga

Keyword(s):

Primary Care ◽

Physical Examination ◽

Likelihood Ratio ◽

Predictive Value ◽

Undescended Testis ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Primary Care Providers ◽

Care Providers ◽

Hospital Patients

Introduction: Although previous evidence has shown that ultrasound is unreliable to diagnose undescended testis, many primary care providers (PCP) continue to misuse it. We assessed the performance of ultrasound as a diagnostic tool for palpable undescended testis, as well as the diagnostic agreement between PCP and pediatric urologists.Methods: We performed a prospective observational cohort study between 2011 and 2013 for consecutive boys referred with a diagnosis of undescended testis to our tertiary pediatric hospital. Patients referred without an ultrasound and those with non-palpable testes were excluded. Data on referring diagnosis, pediatric urology examination and ultrasound reports were analyzed.Results: Our study consisted of 339 boys. Of these, patients without an ultrasound (n = 132) and those with non-palpable testes (n = 38) were excluded. In the end, there were 169 pateints in this study. Ultrasound was performed in 50% of referred boys showing 256 undescended testis. The mean age at time of referral was 45 months. When ultrasound was compared to physical examination by the pediatric urologist, agreement was only 34%. The performance of ultrasound for palpable undescended testis was: sensitivity = 100%; specificity = 16%; positive predictive value = 34%; negative predictive value = 100%; positive likelihood ratio = 1.2; and negative likelihood ratio = 0. Diagnosis of undescended testis by PCP was confirmed by physical examination in 30% of cases, with 70% re-diagnosed with normal or retractile testes.Conclusion: Ultrasound performed poorly to assess for palpable undescended testis in boys and should not be used. Although the study has important limitations, there is an increasing need for education and evidence-based guidelines for PCP in the management of undescended testis.

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Predictive Value of Interim PET/CT in DLBCL Treated with R-CHOP: Meta-Analysis

BioMed Research International ◽

10.1155/2015/648572 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 11

Author(s):

Na Sun ◽

Jinhua Zhao ◽

Wenli Qiao ◽

Taisong Wang

Keyword(s):

Likelihood Ratio ◽

Predictive Value ◽

Meta Analysis ◽

Prognostic Significance ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Chop Chemotherapy ◽

Interim Pet ◽

Pet Ct ◽

Fdg Pet Ct

Objective.We conducted a meta-analysis to evaluate the predictive value of interim18F-FDG PET/CT in patients with DLBCL treated with R-CHOP chemotherapy.Methods.We searched for articles published in PubMed, ScienceDirect, Wiley, Scopus, and Ovid database from inception to March 2014. Articles related to interim PET/CT in patients with DLBCL treated with R-CHOP chemotherapy were selected. PFS with or without OS was chosen as the endpoint to evaluate the prognostic significance of interim PET/CT.Results.Six studies with a total of 605 cases were included. The sensitivity of interim PET/CT ranged from 21.2% to 89.7%, and the pooled sensitivity was 52.4%. The specificity of interim PET/CT ranged from 37.4% to 90.7%, and the pooled specificity was 67.8%. The pooled positive likelihood ratio and negative likelihood ratio were 1.780 and 0.706, respectively. The explained AUC was 0.6978 and theQ*was 0.6519.Conclusions.The sensitivity and specificity of interim PET/CT in predicting the outcome of DLBCL patients treated with R-CHOP chemotherapy were not satisfactory (52.4% and 67.8%, resp.). To improve this, some more work should be done to unify the response criteria and some more research to assess the prognostic value of interim PET/CT with semiquantitative analysis.

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Classification of Thyroid Nodules with Stacked Denoising Sparse Autoencoder

International Journal of Endocrinology ◽

10.1155/2020/9015713 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Zexin Li ◽

Kaiji Yang ◽

Lili Zhang ◽

Chiju Wei ◽

Peixuan Yang ◽

...

Keyword(s):

Likelihood Ratio ◽

Predictive Value ◽

Thyroid Nodules ◽

Area Under The Curve ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Discriminative Ability ◽

Sparse Autoencoder ◽

Immune Related Genes

Purpose. Several commercial tests have been used for the classification of indeterminate thyroid nodules in cytology. However, the geographic inconvenience and high cost confine their widespread use. This study aims to develop a classifier for conveniently clinical utility. Methods. Gene expression data of thyroid nodule tissues were collected from three public databases. Immune-related genes were used to construct the classifier with stacked denoising sparse autoencoder. Results. The classifier performed well in discriminating malignant and benign thyroid nodules, with an area under the curve of 0.785 [0.638–0.931], accuracy of 92.9% [92.7–93.0%], sensitivity of 98.6% [95.9–101.3%], specificity of 58.3% [30.4–86.2%], positive likelihood ratio of 2.367 [1.211–4.625], and negative likelihood ratio of 0.024 [0.003–0.177]. In the cancer prevalence range of 20–40% for indeterminate thyroid nodules in cytology, the range of negative predictive value of this classifier was 37–61%, and the range of positive predictive value was 98–99%. Conclusion. The classifier developed in this study has the superb discriminative ability for thyroid nodules. However, it needs validation in cytologically indeterminate thyroid nodules before clinical use.

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Predictive value of pregnancy-associated plasma protein-A in relation to fetal loss: A systematic review and meta-analysis

International Journal of Reproductive BioMedicine ◽

10.18502/ijrm.v13i6.7281 ◽

2020 ◽

Author(s):

Zahra Hadizadeh-Talasaz ◽

Ali Taghipour ◽

Seyede Houra Mousavi-Vahed ◽

Robab Latifnejad Roudsari

Keyword(s):

Systematic Review ◽

Likelihood Ratio ◽

Plasma Protein ◽

Predictive Value ◽

Meta Analysis ◽

Protein A ◽

Fetal Loss ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Forest Plot

Background: For a woman with bleeding and threatened abortion, ultrasound scan is done to confirm the viability of the fetus; however, 10-15% of the embryos are eventually aborted. Distinguishing between women with good and poor prognosis can be a helpful approach. Objective: This study aimed to review the predictive value of Pregnancy-associated Plasma Protein A (PAPP-A) in relation to the diagnosis of fetal loss. Materials and Methods: The articles published in multiple databases including Web of Science, PubMed, MEDLINE, Scopus, and Persian databases such as ISC, Magiran, and IranMedx were searched for articles published until May 2019. MeSH terms was used for searching the databases including fetal loss OR pregnancy loss OR abortion OR miscarriage with the following word using AND; Pregnancy-Associated Plasma Protein- A OR PAPP-A. Two reviewers extracted data and recorded them in a pre-defined form and assessed the quality of articles using the Newcastle-Ottawa tool. Meta-analysis was done using the Comprehensive Meta-Analysis/2.0 software and MetaDisc. Results: A total number of 16 studies were eligible for the qualitative data synthesis, out of which 8 studies were included in the meta-analysis. All studies had high and medium quality. The forest plot analysis showed a sensitivity of 57% (95% CI: 53-63%), a specificity of 83% (95% CI: 80-85%), a positive likelihood ratio of 3.52 (95% CI: 2.44- 5.07), a negative likelihood ratio of 0.54 (95% CI: 0.37-0.79), and a diagnostic odds ratio of 6.95 (95% CI: 3.58-13.50). Conclusion: PAPP-A cannot be recommended on a routine basis for predicting fetal loss and still further research with a combination of other biomarkers is required. Key words: Pregnancy-associated plasma protein-A, Fetal loss, Pregnancy, Systematic review.

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