Prediction of bacteremia in emergency department patients with suspected infection: an external validation of a clinical decision rule

Jessen, Marie K.; Mackenhauer, Julie; Hvass, Anne Mette Fløe; Skibsted, Simon; Kirkegaard, Hans; Schønheyder, Henrik Carl; Shapiro, Nathan I.

doi:10.1186/cc12923

Cited by 19 publications

(49 citation statements)

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“…AUC was 0.80 (0.74 to 0.86) (see figure 2)—similar to that found in Shapiro's derivation (0.80) and validation (0.75) groups and the recently published external validation study (0.83) 28. The Hosmer–Lemeshow p value was 0.45.…”

Section: Resultssupporting

confidence: 86%

“…This study provides further external validation of the CPR proposed by Shapiro et al 27 uniquely in an acute medical UK cohort, with similar results to the original study and other external validation study 28. The initial CPR was proposed to reduce routine (potentially inappropriate) ordering of BCs and also highlighted a group at high risk of bacteraemia.…”

Section: Discussionsupporting

confidence: 66%

“…None have undergone an impact analysis—unfortunately true of most CPRs in the medical literature 26. One CPR with major and minor criteria27—the ‘Shapiro criteria’ (see table 1)—has been shown to be a sensitive but not specific predictor, and was recently validated in an emergency department (ED) setting 28. The objective of this study was to provide further external validation of the Shapiro criteria in an acute medical unit (AMU) population.…”

Section: Introductionmentioning

confidence: 99%

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An external validation study of a clinical prediction rule for medical patients with suspected bacteraemia

et al. 2015

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ObjectiveThe objective of this study was to externally validate a clinical prediction rule (CPR)—the ‘Shapiro criteria’—to predict bacteraemia in an acute medical unit (AMU).MethodsProspectively collected data, retrospectively evaluated over 11 months in an AMU in the UK. From 4810 admissions, 635 patients (13%) had blood cultures (BCs) performed. The 100 cases of true bacteraemia were compared with a randomly selected sample of 100 control cases where BCs were sterile.ResultsTo predict bacteraemia (at a cut-off score of two points), the Shapiro criteria had a sensitivity of 97% (95% CIs 91% to 99%), specificity 37% (28% to 47%), positive likelihood ratio 1.54 (1.3 to 1.8) and a negative likelihood ratio of 0.08 (0.03 to 0.25). The area under the receiver operating curve was 0.80 (0.74 to 0.86), and the Hosmer–Lemeshow p value was 0.45.ConclusionsA cut-off score of two points on the Shapiro criteria had high sensitivity to predict bacteraemia in a study of acute general medical admissions. Application of the rule in patients being considered for a BC could identify those at low risk of bacteraemia. Though the model demonstrated good discrimination, the lengthy number of variables (13) and difficulty automating the CPR may limit its use.

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Section: Resultssupporting

confidence: 86%

Section: Discussionsupporting

confidence: 66%

Section: Introductionmentioning

confidence: 99%

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An external validation study of a clinical prediction rule for medical patients with suspected bacteraemia

et al. 2015

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“…The prior studies validating the Shapiro rule, Shapiro et al . and Jessen et al ., produced similar excellent sensitivities to our modified rule, showing the rule is safe in a variety of settings . The specificity of 49% in this study is similar or better than shown in the prior studies (Jessen et al .…”

Section: Discussionsupporting

confidence: 85%

“…Shapiro et al . designed a simple predictive rule that has been shown to predict bacteraemia with high sensitivity in an American and European context (Table ) . The modified rule as applied in our context is designed to allow safe omission of blood cultures in a circumstance where bacteraemia is clinically considered.…”

Section: Introductionmentioning

confidence: 99%

Blood cultures and bacteraemia in an Australian emergency department: Evaluating a predictive rule to guide collection and their clinical impact

Brown

Chapman

Ferguson

2016

Emerg Medicine Australasia

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Diagnostic stewardship for blood cultures in the emergency department: A multicenter validation and prospective evaluation of a machine learning prediction tool

et al. 2022

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Prediction of bacteremia in emergency department patients with suspected infection: an external validation of a clinical decision rule

Cited by 19 publications

References 1 publication

An external validation study of a clinical prediction rule for medical patients with suspected bacteraemia

An external validation study of a clinical prediction rule for medical patients with suspected bacteraemia

Blood cultures and bacteraemia in an Australian emergency department: Evaluating a predictive rule to guide collection and their clinical impact

Diagnostic stewardship for blood cultures in the emergency department: A multicenter validation and prospective evaluation of a machine learning prediction tool

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