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Development and validation of a screening tool for early identification of bloodstream infection in older patients – a retrospective case-control study

BACKGROUND: Delayed diagnosis of bloodstream infection (BSI) occurs in > 20% of older patients, with misdiagnosis in 35%. Our objective was to develop and validate a clinically useful screening tool to identify older patients with a high probability of having a BSI. METHODS: Hospitalized patients...

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Autores principales: Walker, Sandra A. N., Bannerman, Heather, Ma, Nathan, Peragine, Christine, Elligsen, Marion, Palmay, Lesley, Williams, Evelyn, Liu, Barbara
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6942330/
https://www.ncbi.nlm.nih.gov/pubmed/31900110
http://dx.doi.org/10.1186/s12877-019-1402-x
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author Walker, Sandra A. N.
Bannerman, Heather
Ma, Nathan
Peragine, Christine
Elligsen, Marion
Palmay, Lesley
Williams, Evelyn
Liu, Barbara
author_facet Walker, Sandra A. N.
Bannerman, Heather
Ma, Nathan
Peragine, Christine
Elligsen, Marion
Palmay, Lesley
Williams, Evelyn
Liu, Barbara
author_sort Walker, Sandra A. N.
collection PubMed
description BACKGROUND: Delayed diagnosis of bloodstream infection (BSI) occurs in > 20% of older patients, with misdiagnosis in 35%. Our objective was to develop and validate a clinically useful screening tool to identify older patients with a high probability of having a BSI. METHODS: Hospitalized patients > 80 years old with BSI (n = 105/group) were evaluated for the tool development in this retrospective matched case-controlled study (learn cohort). The tool was validated in different retrospectively matched case and control patients > 80 years old (n = 120/group) and 65 to 79 years old (n = 250/group) (test cohort). Binary logistic regression was used to develop a screening tool using laboratory and clinical parameters that were significantly associated with BSI (P < 0.05; adjusted odds ratio (OR) > 1); and Classification and Regression Tree (CART) analysis was used to identify parameter breakpoints. Performance metrics were used to evaluate and validate the tool. RESULTS: The significant parameters associated with BSI were maximum temperature (Tmax)(> 37.55C)(OR = 42.575), neutrophils (> 7.95)(OR = 1.923), a change in level of consciousness (LOC) (Yes = 1, No = 0)(OR = 1.571), blood urea nitrogen (BUN)(> 10.05)(OR = 1.359), glucose (> 7.35)(OR = 1.167), albumin (< 33.5)(OR = 1.038) and alanine aminotransferase (ALT) (> 19.5)(OR = 1.005). The optimal screening tool [Ln (odds of BSI) = − 150.299 + 3.751(Tmax) + 0.654(neutrophils) + 0.452(change in LOC) + 0.307(BUN) + 0.154(glucose) + 0.038(albumin) + 0.005(ALT)] had favorable performance metrics in the learn and test cohorts (sensitivity, specificity and accuracy of 95% in the learn cohort and 77, 89, and 81% in the total test cohort); and performed better than using only temperature and neutrophil count. CONCLUSIONS: The validated tool had high predictive value which may improve early identification and management of BSI in older patients.
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spelling pubmed-69423302020-01-07 Development and validation of a screening tool for early identification of bloodstream infection in older patients – a retrospective case-control study Walker, Sandra A. N. Bannerman, Heather Ma, Nathan Peragine, Christine Elligsen, Marion Palmay, Lesley Williams, Evelyn Liu, Barbara BMC Geriatr Research Article BACKGROUND: Delayed diagnosis of bloodstream infection (BSI) occurs in > 20% of older patients, with misdiagnosis in 35%. Our objective was to develop and validate a clinically useful screening tool to identify older patients with a high probability of having a BSI. METHODS: Hospitalized patients > 80 years old with BSI (n = 105/group) were evaluated for the tool development in this retrospective matched case-controlled study (learn cohort). The tool was validated in different retrospectively matched case and control patients > 80 years old (n = 120/group) and 65 to 79 years old (n = 250/group) (test cohort). Binary logistic regression was used to develop a screening tool using laboratory and clinical parameters that were significantly associated with BSI (P < 0.05; adjusted odds ratio (OR) > 1); and Classification and Regression Tree (CART) analysis was used to identify parameter breakpoints. Performance metrics were used to evaluate and validate the tool. RESULTS: The significant parameters associated with BSI were maximum temperature (Tmax)(> 37.55C)(OR = 42.575), neutrophils (> 7.95)(OR = 1.923), a change in level of consciousness (LOC) (Yes = 1, No = 0)(OR = 1.571), blood urea nitrogen (BUN)(> 10.05)(OR = 1.359), glucose (> 7.35)(OR = 1.167), albumin (< 33.5)(OR = 1.038) and alanine aminotransferase (ALT) (> 19.5)(OR = 1.005). The optimal screening tool [Ln (odds of BSI) = − 150.299 + 3.751(Tmax) + 0.654(neutrophils) + 0.452(change in LOC) + 0.307(BUN) + 0.154(glucose) + 0.038(albumin) + 0.005(ALT)] had favorable performance metrics in the learn and test cohorts (sensitivity, specificity and accuracy of 95% in the learn cohort and 77, 89, and 81% in the total test cohort); and performed better than using only temperature and neutrophil count. CONCLUSIONS: The validated tool had high predictive value which may improve early identification and management of BSI in older patients. BioMed Central 2020-01-03 /pmc/articles/PMC6942330/ /pubmed/31900110 http://dx.doi.org/10.1186/s12877-019-1402-x Text en © The Author(s). 2020 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Walker, Sandra A. N.
Bannerman, Heather
Ma, Nathan
Peragine, Christine
Elligsen, Marion
Palmay, Lesley
Williams, Evelyn
Liu, Barbara
Development and validation of a screening tool for early identification of bloodstream infection in older patients – a retrospective case-control study
title Development and validation of a screening tool for early identification of bloodstream infection in older patients – a retrospective case-control study
title_full Development and validation of a screening tool for early identification of bloodstream infection in older patients – a retrospective case-control study
title_fullStr Development and validation of a screening tool for early identification of bloodstream infection in older patients – a retrospective case-control study
title_full_unstemmed Development and validation of a screening tool for early identification of bloodstream infection in older patients – a retrospective case-control study
title_short Development and validation of a screening tool for early identification of bloodstream infection in older patients – a retrospective case-control study
title_sort development and validation of a screening tool for early identification of bloodstream infection in older patients – a retrospective case-control study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6942330/
https://www.ncbi.nlm.nih.gov/pubmed/31900110
http://dx.doi.org/10.1186/s12877-019-1402-x
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