scholarly journals Predictors of Recurrence after a First Unprovoked Seizure in Childhood: A Prospective Study

2021 ◽  
Vol 2 (3) ◽  
pp. 77-80
Author(s):  
N. Akter ◽  
M. M. Rahman ◽  
S. Akhter ◽  
K. Fatema ◽  
S. M. B. Billah
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Status Epilepticus ◽  
High Risk ◽  
Prospective Study ◽  
Recurrence Rate ◽  
Significant Risk ◽  
High Risk Group ◽  
First Episode ◽  
Unprovoked Seizure

The second part of the revised definition of epilepsy by ILAE in 2014 allows a condition to be considered epilepsy after one seizure if there is a high risk of having another seizure; if the risk factor is not precisely be known we have to wait for another seizure. This definition necessitates search for probable risk factors. We aimed this study to assess the recurrence rate and associated risk factors for recurrences after a first unprovoked seizure in children within two years of first attack. This prospective study was conducted on in Banglabandhu Sheikh Mujib Medical University (BSMMU) from June 2016 to December 2018. Among 137 children finally 120 children aged between1 month to 14 years after a first seizure were followed up for 2 years. Diagnosis of seizure was confirmed on the basis of diagnostic criteria and none of the children was treated by any antiepileptic drugs after first episode. Overall recurrence rate within 2 years of follow up was 38%. Majority of recurrence (65%) observed within 6-10 months of initial seizure. Significant risk factors were an abnormal EEG finding (p=<0.001), focal seizure (p=<0.001), seizure at sleep (p=0.001) and initial presentation with status epilepticus (p=0.001). Abnormal neuroimage findings were also associated with seizure recurrence, but it was not statistically significant. Age of the patients and underlying motor and cognitive delay was not a significant risk factor for recurrence. A great percentage of first seizure didn’t show recurrence but there are so many factors can determine the possibilities of recurrence, early identification of risk factors specially the focal pattern of seizure, seizure in sleep, status epilepticus and abnormal electrophysiology are the best predictive factors of recurrence, so identifying the high risk group of recurrence helps to initiate early antiepileptic drug and prevent further recurrence.

scholarly journals Intensive Multiagent Therapy, Including Dose-Compressed Cycles of Ifosfamide/Etoposide and Vincristine/Doxorubicin/Cyclophosphamide, Irinotecan, and Radiation, in Patients With High-Risk Rhabdomyosarcoma: A Report From the Children's Oncology Group

2016 ◽  
Vol 34 (2) ◽  
pp. 117-122 ◽  
Author(s):  
Brenda J. Weigel ◽  
Elizabeth Lyden ◽  
James R. Anderson ◽  
William H. Meyer ◽  
David M. Parham ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Bone Marrow Involvement ◽  
High Risk Group ◽  
Historical Cohort ◽  
Dismal Prognosis ◽  
Risk Patients ◽  
Metastatic Sites

Purpose Patients with metastatic rhabdomyosarcoma (RMS), except those younger than 10 years with embryonal RMS, have an estimated long-term event-free survival (EFS) of less than 20%. The main goal of this study was to improve outcome of patients with metastatic RMS by dose intensification with interval compression, use of the most active agents determined in phase II window studies, and use of irinotecan as a radiation sensitizer. Patients and Methods Patients with metastatic RMS received 54 weeks of therapy: blocks of therapy with vincristine/irinotecan (weeks 1 to 6, 20 to 25, and 47 to 52), interval compression with vincristine/doxorubicin/cyclophosphamide alternating with etoposide/ifosfamide (weeks 7 to 19 and 26 to 34), and vincristine/dactinomycin/cyclophosphamide (weeks 38 to 46). Radiation therapy occurred at weeks 20 to 25 (primary) but was also permitted at weeks 1 to 6 (for intracranial or paraspinal extension) and weeks 47 to 52 (for extensive metastatic sites). Results One hundred nine eligible patients were enrolled, with a median follow-up of surviving patients of 3.8 years (3-year EFS for all patients, 38% [95% CI, 29% to 48%]; survival, 56% [95% CI, 46% to 66%]). Patients with one or no Oberlin risk factor (age > 10 years or < 1 year, unfavorable primary site of disease, ≥ three metastatic sites, and bone or bone marrow involvement) had a 3-year EFS of 69% (95% CI, 52% to 82%); high-risk patients with two or more risk factors had a 3-year EFS of 20% (95% CI, 11% to 30%). Toxicity was similar to that on prior RMS studies. Conclusion Patients with metastatic RMS with one or no Oberlin risk factor had an improved 3-year EFS of 69% on ARST0431 compared with an historical cohort from pooled European and US studies; those with two or more risk factors have a dismal prognosis, and new approaches are needed for this very-high-risk group.

A risk-factor analysis of medical litigation judgments related to fall injuries in Korea

2017 ◽  
Vol 58 (1) ◽  
pp. 16-24
Author(s):  
Insook Kim ◽  
Seonae Won ◽  
Mijin Lee ◽  
Won Lee
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Environmental Factors ◽  
Fall Prevention ◽  
Systems Approach ◽  
Risk Group ◽  
Past History ◽  
High Risk Group ◽  
Fall Injuries

The aim of this study was to find out the risk factors through analysis of seven medical malpractice judgments related to fall injuries. The risk factors were analysed by using the framework that approaches falls from a systems perspective and comprised people, organisational or environmental factors, with each factor being comprised of subfactors. The risk factors found in each of the seven judgments were aggregated into one framework. The risk factors related to patients (i.e. the people factor) were age, pain, related disease, activities and functional status, urination state, cognitive function impairment, past history of fall, blood transfusion, sleep endoscopy state and uncooperative attitude. The risk factors related to the medical staff and caregivers (i.e. people factor) were observation negligence, no fall prevention activities and negligence in managing high-risk group for fall. Organisational risk factors were a lack of workforce, a lack of training, neglecting the management of the high-risk group, neglecting the management of caregivers and the absence of a fall prevention procedure. Regarding the environment, the risk factors were found to be the emergency room, chairs without a backrest and the examination table. Identifying risk factors is essential for preventing fall accidents, since falls are preventable patient-safety incidents. Falls do not happen as a result of a single risk factor. Therefore, a systems approach is effective to identify risk factors, especially organisational and environmental factors.

Advanced stage, elevated LDH, primary sites, but not adolescent (A) age (≥ 15 years) as risk factors for disease progression in childhood (C) and adolescent (A) mature B-NHL: Report of the FAB/LMB 96 international trial

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 10032-10032
Author(s):  
M. S. Cairo ◽  
R. Sposto ◽  
M. Gerrard ◽  
I. Waxman ◽  
S. Goldman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Risk Factor ◽  
Risk Group ◽  
Significant Risk ◽  
High Risk Group ◽  
Stage Iii ◽  
Group A ◽  
Independent Risk Factors ◽  
Group B

10032 Background: We recently reported the results in C & A with low risk (group A), intermediate risk (group B) and high risk (group C) mature B-NHL treated on FAB/LMB 96 (Gerrard et al, Br J Haematol, 2008; Patte et al, Blood, 2007; Cairo et al, Blood, 2007, respectively). Adolescent age (15–21 yrs) has historically been considered to be an independent risk factor for poor outcome in subsets of mature B-NHL (Hochberg/Cairo et al, Br J Haematol, 2008; Burkhardt et al, Br J Haematol 2005; Cairo et al, Br J Haematol, 2003). Methods: We analyzed the EFS of all pts treated on FAB/LMB 96 and the following risk factors were significant in a univariate and Cox multivariate analysis: age (<15 vs ≥15 yrs), stage I/II vs III/IV, primary sites, LDH <2 vs ≥2 NL and histology (DLBCL vs BL/BLL). Results: 1111 pts (15%, 15–21 years) were treated with group A (N = 132), group B (N = 744), and group C (N = 235) therapy. Five year EFS (CI95) for all, A, B, C pts was 86% (84%,88%), 98% (93%, 100%), 87%% (84%, 89%), and 79%% (73%,84%), respectively. Age (≥15 yrs), LDH ≥2NL, stage III/IV, and BM+/CNS+ and histology were significant univariate risk factors for decreased EFS (P<0.045, <0.0001, <0.0001, <0.0001, and <0.0001 respectively). Multivariate analysis demonstrated age ≥15 yrs and DLBCL histology were no longer independent significant risk factors (p = .82 and 0.08, respectively), but LDH (RR 2.0, p = .001), stage III/IV (RR 3.8, p<0.001), and primary sites including PMBL (RR 4.0, p<.001) and BM+/CNS+ (RR 2.8, p<0.001) were independent significant risk factors for poorer outcome. Conclusions: With the use of modern short but intense FAB-LMB 96 therapy, adolescent age is no longer a poor risk factor in children with mature B-NHL. The independent risk factors identified in this study (stage, LDH, primary site) for decreased EFS in C & A mature B-NHL will form the basis of the next risk adapted international pediatric mature B-NHL trial. No significant financial relationships to disclose.

Young Adults with Mild Asthma in a High-Risk Occupation: Incidence and Risk Factors for Exacerbation

2021 ◽  
pp. 1-8
Author(s):  
Michael Shapiro ◽  
Konstantin Zubkov ◽  
Yossi Rosman ◽  
Regev Landau
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Risk Factor ◽  
High Risk ◽  
Asthma Exacerbation ◽  
Significant Risk ◽  
Mild Asthma ◽  
Risk Environment ◽  
Combat Training ◽  
Intermittent Asthma

<b><i>Background:</i></b> The effects of high-risk environment on young adults with mild asthma were never fully tested in practice, as most high-risk occupations do not welcome them. This study examines the effect of combat training on asthma worsening in the Israeli Defense Forces. <b><i>Methods:</i></b> Persons with asthma in remission and mild intermittent asthma who underwent combat training between 2014 and 2017 were compared in terms of disease worsening to their counterparts performing clerical duties during a follow-up of 8 months. Among combat trainees, exposure to known triggers for asthma exacerbation and health status on enlistment were assessed as risk factors for asthma exacerbation. <b><i>Results:</i></b> Asthma worsening among persons with asthma in remission was twice as common among those who are undergoing training compared to persons performing clerical duties. This difference was smaller among mild intermittent asthmatics. For both asthma severities, rates of asthma exacerbation requiring emergency room treatment were several times higher among the training group. Among individuals undergoing training, mild intermittent asthma was a significant risk factor for asthma worsening compared to asthma in remission (OR 1.99 [1.44–2.75]) while age (OR 0.67 [0.53–0.85]) and immigration to Israel (OR 0.55 [0.31–0.95]) were significant protective factors. <b><i>Interpretation:</i></b> Young adults with mild asthma are at significant risk for severe exacerbations when exposed to high-risk environment even among individuals who have long been symptom free. No single risk factor was found to have an independent effect suggesting a synergistic mechanism that is harder to mitigate.

Cannabis Use is Not Associated With the Development of Psychosis in an ‘Ultra’ High-Risk Group

2002 ◽  
Vol 36 (6) ◽  
pp. 800-806 ◽  
Author(s):  
Lisa J Phillips ◽  
Christina Curry ◽  
Alison R Yung ◽  
Hok Pan Yuen ◽  
Steven Adlard ◽  
...  
Keyword(s):  
Risk Factor ◽  
High Risk ◽  
Psychotic Disorder ◽  
Risk Group ◽  
High Risk Group ◽  
Cannabis Use ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Psychotic Episode ◽  
Ultra High Risk

Background: The association between cannabis use and the development of a first psychotic episode was studied in a group of 100 young people identified as being at very high risk for the onset of psychosis. Method: The ‘ultra’ high risk cohort was identified by the presence of subthreshold psychotic symptoms, or a combination of first-degree relative with a psychotic disorder and recent functional decline. Thirty-two per cent of the cohort developed an acute psychotic episode over the 12-month period after recruitment. As a component of a larger research study, the level of cannabis use by participants in the year prior to enrolment in the study was assessed at intake. Results: Cannabis use or dependence in the year prior to recruitment to this study was not associated with a heightened risk of developing psychosis over the following 12-month period and therefore did not appear to contribute to the onset of a psychotic disorder. Conclusion: The results of this study suggest that cannabis use may not play an integral role in the development of psychosis in a high-risk group. While this study does not support a role for cannabis in the development of first-episode psychosis, we cannot conclude that cannabis use should be completely ignored as a candidate risk factor for onset of psychosis. A number of weaknesses of the study (the low level of cannabis use in the current sample, the lack of monitoring of cannabis use after intake) suggest that it may be premature to dismiss cannabis use as a risk factor for the development of psychosis and further research is urged in this area.

scholarly journals TINGKAT KECEMASAN IBU HAMIL TRIMESTER III BERDASARKAN KELOMPOK FAKTOR RESIKO KEHAMILAN

2020 ◽  
Vol 2 (1) ◽  
pp. 16
Author(s):  
Ika Septiana Saputri ◽  
Ika Yudianti
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Risk Group ◽  
High Risk Group ◽  
P Value ◽  
Pregnancy Risk ◽  
Cross Sectional ◽  
Work Area ◽  
Anxiety Levels

Kecemasan pada ibu bahkan yang mempunyai resiko kehamilan yang tinggi dapat memicu terjadinya rangsangan kontraksi rahim sehingga mampu mengakibatkan preeklampsi dan keguguran, kelahiran Bayi Berat Lahir Rendah dan bayi prematur. Perlunya melakukan pengkajian tingkat kecemasan sehingga tidak mengakibatkan komplikasi dalam kehamilan. Tujuan dari penelitian ini yaitu untuk mengetahui perbedaan tingkat kecemasan ibu hamil trimester III berdasarkan kelompok faktor resiko kehamilan Desain penelitian menggunakan analitik komparasi dengan pendekatan cross-sectional. Penelitian ini menggunakan teknik Purposive sampling. Sampel berjumlah 51 orang yang memenuhi kriteria inklusi yaitu tercatat didalam kohort dengan usia kehamilan 28-37 minggu di Wilayah Kerja Puskesmas Gribig, mengetahui faktor resiko kehamilannya, dapat membaca dan menulis, serta bersedia menjadi responden. Analisis data menggunakan uji Kruskall Wallis. Pengumpulan data menggunakan kuesioner ZSAS yang telah dimodifikasi. Hasil uji statistik p value (0,000) < α = (0,05) maka Ho ditolak yang berarti terdapat perbedaan antara Tingkat Kecemasan Ibu Hamil Trimester III berdasarkan Kelompok Faktor Resiko Kehamilan di Wilayah Kerja Puskesmas Gribig Kecamatan Kedungkandang Kota Malang. Mayoritas responden yang termasuk kelompok resiko rendah (88,9%) mengalami tingkat kecemasan ringan, kelompok resiko tinggi (86,7%) mengalami tingkat kecemasan sedang, dan kelompok resiko sangat tinggi (66,7%) mengalami tingkat kecemasan berat. Dari hasil penelitian tersebut, menunjukkan bahwa semakin tinggi faktor resiko yang dialami akan semakin tinggi pula tingkat kecemasan. Sehingga diharapkan bidan dapat memberikan KIE tentang hasil skrinning kelompok faktor resiko kehamilan, serta meningkatkan perhatian dan empati pada ibu hamil yang sangat membutuhkan infomasi lebih mengenai kehamilan guna dapat mengatasi kecemasan yang terjadi. Anxiety in mothers even who have a high risk of pregnancy can trigger stimulation of uterine contractions so that it can lead to preeclampsia and miscarriage, low birth weight birth (LBW) and premature babies. The need to assess anxiety levels so that they do not cause complications in pregnancy. The purpose of this study is to determine differences in anxiety levels of third trimester pregnant women based on pregnancy risk factor groups. The study design uses comparative analytics with cross-sectional approaches. This research uses purposive sampling technique. A sample of 51 people who met the inclusion criteria was recorded in a cohort with 28-37 weeks' gestation in the Gribig Community Health Center Work Area, knew the risk factors for pregnancy, could read and write, and was willing to be respondents. Data analysis using the Kruskall Wallis test. Data collection uses a modified ZSAS questionnaire. Statistical test results p value (0,000) <α = (0.05) then Ho is rejected, which means there is a difference between the Anxiety Levels of Trimester III Pregnancy based on Pregnancy Risk Factors in Gribig Puskesmas Work Area in Kedungkandang District, Malang. The majority of respondents who belong to the low risk group (88.9%) experienced mild anxiety levels, the high risk group (86.7%) experienced moderate anxiety levels, and the very high risk group (66.7%) experienced severe anxiety levels. From the results of the study, showed that the higher the risk factors experienced the higher the level of anxiety. It is hoped that midwives can provide IEC about the screening results of pregnancy risk factor groups, and increase the attention and empathy of pregnant women who really need more information about pregnancy in order to overcome the anxiety that occurs.

scholarly journals RISK FACTORS FOR PREMATURE BIRTH. IS EVERYTHING UNAMBIGU-OUS?

2021 ◽  
Vol 9 (1) ◽  
pp. 77-90
Author(s):  
I.V. Galinova ◽  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Premature Birth ◽  
Risk Group ◽  
Polycystic Ovary ◽  
Asymptomatic Bacteriuria ◽  
High Risk Group ◽  
Ovary Syndrome ◽  
History Of

Aim. Despite the fact that ischemic-cervical insufficiency (ICI) is considered to be a risk factor for preterm birth (PB), a comparative analysis of the risk factors for each complication of gestation (ICI and PB) showed considerable differences. This was the reason for conducting a study to identify the most significant risk factors for PB and ICI. Materials and Methods. A questionnaire survey of 267 pregnant women was carried out to study the anamnestic risk factors for PR and for assessment of the course and outcomes of the current pregnancy. The existence of statistically significant differences was determined using Fishers exact test, and the ranking of risk factors was performed by the value of x2 criterion, adjusted for likelihood. Results. Pregnancy ended prematurely in 14 women (5.2%). Extremely early PB made 14.3% among all PB, premature births – 21.4%, late births – 64.3%, early PB were absent. Spontaneous and induced PB occurred with the same frequency – 50% each in the PB structure. Based on the x2 calculation, a rating of the PB risk factors was made. The 1st place – history of induced PB, 2 – history of polycystic ovary syndrome; 3 – in vitro fertilization; 4 – arterial hypertension; 5 – asymptomatic bacteriuria; 6 – ICI; 7 – hypothyroidism; 8 – the premature birth of the father. Also, an assessment of the risk factors for ICI was carried out and their rating was compiled: 1 – intra-uterine interventions before the first birth; 2 – repeated intrauterine interventions; 3 – history of ICI. Conclusion. Women with endocrine disorders (thyroid disease, polycystic ovary syndrome), arterial hypertension before and during pregnancy, physical inactivity before pregnancy should be considered a high risk group for PB. Asymptomatic bacteriuria is a risk factor not only for PB, but also for ICI, in which connection its early detection and rehabilitation is advisable. In the course of our study, the necessity for cervicometry during the 1st ultrasound screening was confirmed, and dynamic cervicometry can be recommended not only for women with PB, late spontaneous miscarriages, history of ICI and ICI in the current pregnancy, but also for pregnant women with repeated intrauterine interventions and with intrauterine interventions before the first forthcoming birth, for the earlier detection of ICI and formation of a high-risk group for PR for arrangement of preventive measures.

scholarly journals The Significance of Staging in the Treatment of Congenital Cholesteatoma in Children

2020 ◽  
pp. 014556132093396
Author(s):  
Jinsheng Hao ◽  
Min Chen ◽  
Bing Liu ◽  
Yang Yang ◽  
Wei Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Recurrence Rate ◽  
Clinical Characteristics ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Stage I ◽  
Stage Iii ◽  
Canal Wall ◽  
Congenital Cholesteatoma

Objectives: To analyze the clinical characteristics of congenital cholesteatoma (CC), to explore the risk factors related to recurrence of the disease, and to clarify the importance of staging for treatment. Methods: A total of 87 patients were followed up for more than 5 years, who had undergone surgical procedures for CC from September 2010 to January 2017 in Beijing Children’s Hospital, Capital Medical University. Patients with CC were identified in accordance with the following Levenson’s criteria. The clinical characteristics of CC on different stage and risk factors related to recurrence of the disease were analyzed. Results: Canal wall up mastoidectomy and tympanoplasty (n = 45), transcanal endoscopic approach (n = 29), and canal wall down mastoidectomy and tympanoplasty (n = 13) was, respectively, performed depending on cholesteatoma extension. Between 2010 and 2013, 20.93% of patients had stage I-II disease, whereas 61.26% had stage I-II disease from 2014 to 2017. Meanwhile, the proportion with stage III-IV disease decreased from 79.07% to 38.64% between these 2 time periods. The preoperative air conduction threshold in patients with stage I, II, III, and IV was, respectively, 23.36 ± 8.20, 45.40 ± 12.82, 47.49 ± 12.03, and 50.37 ± 11.80 dB. The stage of disease was a significant risk factor regarding recurrence ( P = .02). Surgery on patients with stage III-IV disease was performed with the aid of a microscope from 2010 to 2013 and with a microscope and endoscope from 2014 to 2017, which reduced the recurrence rate from 26.92% in the former period to 8.33% in the latter period. Conclusion: Early detection of CC is crucial regarding the facilitation of minimally invasive surgery and reducing complication and recurrence rates. The stage of the disease is a significant risk factor regarding recurrence. The surgery shows us the possibility of reducing the recurrence rate of CC, which is performed under a microscope and an endoscope.

Prevention of Preterm Birth

2018 ◽  
Vol 11 (2) ◽  
pp. 95-104
Author(s):  
Ivan D. Ivanov ◽  
Stefan A. Buzalov ◽  
Nadezhda H. Hinkova
Keyword(s):  
Risk Factors ◽  
Preterm Birth ◽  
High Risk ◽  
Medical Science ◽  
Secondary Prophylaxis ◽  
High Risk Group ◽  
Screening Methods ◽  
Perinatal Complications ◽  
Social Significance ◽  
Neonatal Deaths

Summary Preterm birth (PTB) is a worldwide problem with great social significance because it is a leading cause of perinatal complications and perinatal mortality. PTB is responsible for more than a half of neonatal deaths. The rate of preterm delivery varies between 5-18% worldwide and has not decreased in recent years, regardless of the development of medical science. One of the leading causes for that is the failure to identify the high-risk group in prenatal care. PTB is a heterogeneous syndrome in which many different factors interfere at different levels of the pathogenesis of the initiation of delivery, finally resulting in delivery before 37 weeks of gestation (wg). The various specificities of risk factors and the unclear mechanism of initiation of labour make it difficult to elaborate standard, unified and effective screening to diagnose pregnant women at high-risk for PTB correctly. Furthermore, they make primary and secondary prophylaxis less effective and render diagnostic and therapeutic measures ineffective and inappropriate. Reliable and accessible screening methods are necessary for antenatal care, and risk factors for PTB should be studied and clarified in search of useful tools to solve issues of risk pregnancies to decrease PTB rates and associated complications.

scholarly journals Proposal for the use of echocardiography in bloodstream infections due to different streptococcal species

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sandra Chamat-Hedemand ◽  
Niels Eske Bruun ◽  
Lauge Østergaard ◽  
Magnus Arpi ◽  
Emil Fosbøl ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
Bloodstream Infections ◽  
Low Risk ◽  
Moderate Risk ◽  
Streptococcal Species ◽  
Very High

Abstract Background Infective endocarditis (IE) is diagnosed in 7–8% of streptococcal bloodstream infections (BSIs), yet it is unclear when to perform transthoracic (TTE) and transoesophageal echocardiography (TOE) according to different streptococcal species. The aim of this sub-study was to propose a flowchart for the use of echocardiography in streptococcal BSIs. Methods In a population-based setup, we investigated all patients admitted with streptococcal BSIs and crosslinked data with nationwide registries to identify comorbidities and concomitant hospitalization with IE. Streptococcal species were divided in four groups based on the crude risk of being diagnosed with IE (low-risk < 3%, moderate-risk 3–10%, high-risk 10–30% and very high-risk > 30%). Based on number of positive blood culture (BC) bottles and IE risk factors (prosthetic valve, previous IE, native valve disease, and cardiac device), we further stratified cases according to probability of concomitant IE diagnosis to create a flowchart suggesting TTE plus TOE (IE > 10%), TTE (IE 3–10%), or “wait & see” (IE < 3%). Results We included 6393 cases with streptococcal BSIs (mean age 68.1 years [SD 16.2], 52.8% men). BSIs with low-risk streptococci (S. pneumoniae, S. pyogenes, S. intermedius) are not initially recommended echocardiography, unless they have ≥3 positive BC bottles and an IE risk factor. Moderate-risk streptococci (S. agalactiae, S. anginosus, S. constellatus, S. dysgalactiae, S. salivarius, S. thermophilus) are guided to “wait & see” strategy if they neither have a risk factor nor ≥3 positive BC bottles, while a TTE is recommended if they have either ≥3 positive BC bottles or a risk factor. Further, a TTE and TOE are recommended if they present with both. High-risk streptococci (S. mitis/oralis, S. parasanguinis, G. adiacens) are directed to a TTE if they neither have a risk factor nor ≥3 positive BC bottles, but to TTE and TOE if they have either ≥3 positive BC bottles or a risk factor. Very high-risk streptococci (S. gordonii, S. gallolyticus, S. mutans, S. sanguinis) are guided directly to TTE and TOE due to a high baseline IE prevalence. Conclusion In addition to the clinical picture, this flowchart based on streptococcal species, number of positive blood culture bottles, and risk factors, can help guide the use of echocardiography in streptococcal bloodstream infections. Since echocardiography results are not available the findings should be confirmed prospectively with the use of systematic echocardiography.

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