How do bacteraemic patients present to the emergency department and what is the diagnostic validity of the clinical parameters; temperature, C-reactive protein and systemic inflammatory response syndrome?

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OBJECTIVE: Although blood cultures are often ordered based on the presence of fever, it is a clinical challenge to identify patients eligible for blood cultures. Our aim was to evaluate the diagnostic value of temperature, C-reactive-protein (CRP), and Systemic Inflammatory Response Syndrome (SIRS) to identify bacteraemic patients in the Medical Emergency Department (MED).

METHODS: A population-based cohort study including all adult patients at the MED at Odense University Hospital between August 1st 2009 - August 31st 2011.

RESULTS: 11,988 patients were admitted to the MED within the study period. Blood cultures were performed on 5,499 (45.9%) patients within 2 days of arrival, of which 418 (7.6%) patients were diagnosed with bacteraemia. This corresponded to 3.5% of all patients. 34.1% of the bacteraemic patients had a normal rectal temperature (36.0°-38.0°C) recorded at arrival, 32.6% had a CRP < 100 mg/L and 28.0% did not fulfil the SIRS criteria.For a temperature cut-point of >38.0°C sensitivity was 0.64 (95% CI 0.59-0.69) and specificity was 0.81 (0.80-0.82) to identify bacteraemic patients.

CONCLUSION: One third of the acute medical bacteraemic patients had a normal temperature at arrival to the MED. A normal temperature combined with a CRP < 100 mg/L and no SIRS criteria, ruled out bacteraemia.

OriginalsprogEngelsk
TidsskriftScandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Vol/bind22
Udgave nummer1
Sider (fra-til)39
ISSN1757-7241
DOI
StatusUdgivet - 2014

Fingeraftryk

Hospital Emergency Service
Cohort Studies
Population
Blood Culture

Citer dette

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title = "How do bacteraemic patients present to the emergency department and what is the diagnostic validity of the clinical parameters; temperature, C-reactive protein and systemic inflammatory response syndrome?",
abstract = "OBJECTIVE: Although blood cultures are often ordered based on the presence of fever, it is a clinical challenge to identify patients eligible for blood cultures. Our aim was to evaluate the diagnostic value of temperature, C-reactive-protein (CRP), and Systemic Inflammatory Response Syndrome (SIRS) to identify bacteraemic patients in the Medical Emergency Department (MED).METHODS: A population-based cohort study including all adult patients at the MED at Odense University Hospital between August 1st 2009 - August 31st 2011.RESULTS: 11,988 patients were admitted to the MED within the study period. Blood cultures were performed on 5,499 (45.9{\%}) patients within 2 days of arrival, of which 418 (7.6{\%}) patients were diagnosed with bacteraemia. This corresponded to 3.5{\%} of all patients. 34.1{\%} of the bacteraemic patients had a normal rectal temperature (36.0°-38.0°C) recorded at arrival, 32.6{\%} had a CRP < 100 mg/L and 28.0{\%} did not fulfil the SIRS criteria.For a temperature cut-point of >38.0°C sensitivity was 0.64 (95{\%} CI 0.59-0.69) and specificity was 0.81 (0.80-0.82) to identify bacteraemic patients.CONCLUSION: One third of the acute medical bacteraemic patients had a normal temperature at arrival to the MED. A normal temperature combined with a CRP < 100 mg/L and no SIRS criteria, ruled out bacteraemia.",
author = "Lindvig, {Katrine Prier} and Henriksen, {Daniel Pilsgaard} and Nielsen, {Stig L{\o}nberg} and Jensen, {Th{\o}ger Gorm} and Kolmos, {Hans J{\o}rn} and Court Pedersen and Vinholt, {Pernille Just} and Lassen, {Annmarie Touborg}",
year = "2014",
doi = "10.1186/1757-7241-22-39",
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volume = "22",
pages = "39",
journal = "Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine",
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TY - JOUR

T1 - How do bacteraemic patients present to the emergency department and what is the diagnostic validity of the clinical parameters; temperature, C-reactive protein and systemic inflammatory response syndrome?

AU - Lindvig, Katrine Prier

AU - Henriksen, Daniel Pilsgaard

AU - Nielsen, Stig Lønberg

AU - Jensen, Thøger Gorm

AU - Kolmos, Hans Jørn

AU - Pedersen, Court

AU - Vinholt, Pernille Just

AU - Lassen, Annmarie Touborg

PY - 2014

Y1 - 2014

N2 - OBJECTIVE: Although blood cultures are often ordered based on the presence of fever, it is a clinical challenge to identify patients eligible for blood cultures. Our aim was to evaluate the diagnostic value of temperature, C-reactive-protein (CRP), and Systemic Inflammatory Response Syndrome (SIRS) to identify bacteraemic patients in the Medical Emergency Department (MED).METHODS: A population-based cohort study including all adult patients at the MED at Odense University Hospital between August 1st 2009 - August 31st 2011.RESULTS: 11,988 patients were admitted to the MED within the study period. Blood cultures were performed on 5,499 (45.9%) patients within 2 days of arrival, of which 418 (7.6%) patients were diagnosed with bacteraemia. This corresponded to 3.5% of all patients. 34.1% of the bacteraemic patients had a normal rectal temperature (36.0°-38.0°C) recorded at arrival, 32.6% had a CRP < 100 mg/L and 28.0% did not fulfil the SIRS criteria.For a temperature cut-point of >38.0°C sensitivity was 0.64 (95% CI 0.59-0.69) and specificity was 0.81 (0.80-0.82) to identify bacteraemic patients.CONCLUSION: One third of the acute medical bacteraemic patients had a normal temperature at arrival to the MED. A normal temperature combined with a CRP < 100 mg/L and no SIRS criteria, ruled out bacteraemia.

AB - OBJECTIVE: Although blood cultures are often ordered based on the presence of fever, it is a clinical challenge to identify patients eligible for blood cultures. Our aim was to evaluate the diagnostic value of temperature, C-reactive-protein (CRP), and Systemic Inflammatory Response Syndrome (SIRS) to identify bacteraemic patients in the Medical Emergency Department (MED).METHODS: A population-based cohort study including all adult patients at the MED at Odense University Hospital between August 1st 2009 - August 31st 2011.RESULTS: 11,988 patients were admitted to the MED within the study period. Blood cultures were performed on 5,499 (45.9%) patients within 2 days of arrival, of which 418 (7.6%) patients were diagnosed with bacteraemia. This corresponded to 3.5% of all patients. 34.1% of the bacteraemic patients had a normal rectal temperature (36.0°-38.0°C) recorded at arrival, 32.6% had a CRP < 100 mg/L and 28.0% did not fulfil the SIRS criteria.For a temperature cut-point of >38.0°C sensitivity was 0.64 (95% CI 0.59-0.69) and specificity was 0.81 (0.80-0.82) to identify bacteraemic patients.CONCLUSION: One third of the acute medical bacteraemic patients had a normal temperature at arrival to the MED. A normal temperature combined with a CRP < 100 mg/L and no SIRS criteria, ruled out bacteraemia.

U2 - 10.1186/1757-7241-22-39

DO - 10.1186/1757-7241-22-39

M3 - Journal article

C2 - 25027551

VL - 22

SP - 39

JO - Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

JF - Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

SN - 1757-7241

IS - 1

ER -