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Title: Identifying Patients with Bacteremia in Community-Hospital Emergency Rooms: A Retrospective Cohort Study.
Authors: Takeshima, Taro
Yamamoto, Yosuke  kyouindb  KAKEN_id  orcid (unconfirmed)
Noguchi, Yoshinori
Maki, Nobuyuki
Gibo, Koichiro
Tsugihashi, Yukio
Doi, Asako
Fukuma, Shingo  kyouindb  KAKEN_id  orcid (unconfirmed)
Yamazaki, Shin
Kajii, Eiji
Fukuhara, Shunichi  kyouindb  KAKEN_id
Author's alias: 福間, 真悟
Issue Date: 29-Mar-2016
Publisher: Public Library of Science
Journal title: PLOS ONE
Volume: 11
Issue: 3
Thesis number: e0148078
Abstract: [Objectives] (1) To develop a clinical prediction rule to identify patients with bacteremia, using only information that is readily available in the emergency room (ER) of community hospitals, and (2) to test the validity of that rule with a separate, independent set of data. [Design] Multicenter retrospective cohort study. [Setting] To derive the clinical prediction rule we used data from 3 community hospitals in Japan (derivation). We tested the rule using data from one other community hospital (validation), which was not among the three “derivation” hospitals. [Participants] Adults (age ≥ 16 years old) who had undergone blood-culture testing while in the ER between April 2011 and March 2012. For the derivation data, n = 1515 (randomly sampled from 7026 patients), and for the validation data n = 467 (from 823 patients). [Analysis] We analyzed 28 candidate predictors of bacteremia, including demographic data, signs and symptoms, comorbid conditions, and basic laboratory data. Chi-square tests and multiple logistic regression were used to derive an integer risk score (the “ID-BactER” score). Sensitivity, specificity, likelihood ratios, and the area under the receiver operating characteristic curve (i.e., the AUC) were computed. [Results] There were 241 cases of bacteremia in the derivation data. Eleven candidate predictors were used in the ID-BactER score: age, chills, vomiting, mental status, temperature, systolic blood pressure, abdominal sign, white blood-cell count, platelets, blood urea nitrogen, and C-reactive protein. The AUCs was 0.80 (derivation) and 0.74 (validation). For ID-BactER scores ≥ 2, the sensitivities for derivation and validation data were 98% and 97%, and specificities were 20% and 14%, respectively. [Conclusions] The ID-BactER score can be computed from information that is readily available in the ERs of community hospitals. Future studies should focus on developing a score with a higher specificity while maintaining the desired sensitivity.
Rights: © 2016 Takeshima et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
DOI(Published Version): 10.1371/journal.pone.0148078
PubMed ID: 27023336
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