Bloodstream infection (BSI) is a common and urgent condition at the emergency department (ED). In order to diagnose BSI, the current guideline fails to mention the juncture at which blood cultures ought to be taken. The decision whether or not to obtain hemoculture is solely based upon clinical judgment and outcomes pertaining to inappropriately ordered blood culture. This study aimed to develop predictive bloodstream infection scoring at the ED employing only clinical factors presented on ED arrival.
This study was conducted retrospectively at the ED, Khon Kaen University Hospital, Thailand. Inclusion criteria encompassed adult patients suspected of infection defined by blood culture collection presented at the ED with intravenous antibiotics initiated during ED visits. Independent positive predictors for positive blood culture were used to create the Quick Bloodstream Infection score (qBSI score) through logistic regression analysis.
A total of 169578 patients visited the ED during the study period. Of those, 12556 patients (7.40%) were suspected of infection. 8177 cases met the study criteria and were categorized according to positive blood culture results, i.e. bloodstream infection (741 patients; 9.06%). Probability of positive blood culture was calculated via aged over 55 years + moderate to severe CKD + solid organ tumor + (2 x liver disease) + (2 x history of fever with chills) + (2 x body temperature of over 38.3 o C). A score of 1 or over rendered 92.98% sensitivity and negative predictive value of 95.65%.
The qBSI score presented effective sensitivity and negative predictive value amid positive blood culture in patients at the ED suspected of infection. Resultant of employing this score may facilitate in the determining of those exhibiting the need for blood culture at the ED.