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
Objective: The 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).
Methods: Prospectively 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.
Results: To 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.
Conclusions: A 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.
124-129
Hodgson, Luke Eliot
202f8157-7783-471c-b629-3f1451b2e442
Dragolea, Nicholas
57fe8de4-1810-4f2a-8bd8-a59a2738aae3
Venn, Richard
adc24ece-fb8d-4c1e-969b-026ca62db4ec
Dimitrov, Borislav D.
366d715f-ffd9-45a1-8415-65de5488472f
Forni, Lui G.
e9ca402c-ea28-4d1a-8c4f-7fbaf205bad8
February 2016
Hodgson, Luke Eliot
202f8157-7783-471c-b629-3f1451b2e442
Dragolea, Nicholas
57fe8de4-1810-4f2a-8bd8-a59a2738aae3
Venn, Richard
adc24ece-fb8d-4c1e-969b-026ca62db4ec
Dimitrov, Borislav D.
366d715f-ffd9-45a1-8415-65de5488472f
Forni, Lui G.
e9ca402c-ea28-4d1a-8c4f-7fbaf205bad8
Hodgson, Luke Eliot, Dragolea, Nicholas, Venn, Richard, Dimitrov, Borislav D. and Forni, Lui G.
(2016)
An external validation study of a clinical prediction rule for medical patients with suspected bacteraemia.
Emergency Medicine Journal, 33 (2), .
(doi:10.1136/emermed-2015-204926).
(PMID:26246024)
Abstract
Objective: The 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).
Methods: Prospectively 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.
Results: To 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.
Conclusions: A 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.
Text
emermed-2015-204926-proofs.pdf
- Accepted Manuscript
More information
Accepted/In Press date: 6 July 2015
e-pub ahead of print date: 5 August 2015
Published date: February 2016
Organisations:
Primary Care & Population Sciences
Identifiers
Local EPrints ID: 390163
URI: http://eprints.soton.ac.uk/id/eprint/390163
ISSN: 1472-0205
PURE UUID: 0e8d15ac-1376-4a59-bbf6-20aa946e0dc0
Catalogue record
Date deposited: 21 Mar 2016 14:53
Last modified: 14 Mar 2024 23:13
Export record
Altmetrics
Contributors
Author:
Luke Eliot Hodgson
Author:
Nicholas Dragolea
Author:
Richard Venn
Author:
Borislav D. Dimitrov
Author:
Lui G. Forni
Download statistics
Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.
View more statistics